REGISTRATION NOW OPEN!

This form is for youth interested in joining Life Teen for our Spring Retreat: March 25th-27th at Life Teen Camp Covecrest.

Student Name*
First Last
Gender
Home Address*
Street Address City State ZIP Code
Student Email*
Student Cell
Student Grade level*
Name of current School
T-shirt Size*
Does your student have any food allergies? If yes, please describe.*
Does your student have any health concerns, allergies, or social anxieties we need to be aware of? If yes, please describe in detail*
Does your student have daily medication?*
If yes, please know you will be required to provide the necessary medication in a ziplock bag, with students name on the bag, and be required to turn it in to Leigh Anne on Friday of the retreat.
- Yes, and I understand the rules about medication (see below)
- No, my student does not have medication
Parent Name*
First Last
Best Phone*
Parent Email*
Are you the emergency contact for the student?*
- Yes, I am. Please use my contact information above
- No, I will provide another name
Emergency Contact Information (if not parent stated above)
Please list the contacts: Name, Phone, and Email
While on retreat, there will be photos taken and your student may be in them. Do we have your permission to use the photos from the retreat to post on our Social Media accounts (Facebook, Instagram and Twitter) and to potentially have them on our Parish website?*
- Yes, you have my permission
- No, you do not have my permission

Life Teen Spring Retreat Registration