Confirmation Retreat Registration Hidden Lake Retreat Center830 Hidden Lake Rd, Dahlonega, GA 30533 Choose one date:November 2-3, 2024January 25-26, 202510:00 Saturday – 12:00 pm Sunday Parent(s) are responsible for transportation to and from the retreat. Confirmation Retreat This form is for our January 25-26 Confirmation Retreat. "*" indicates required fields Candidate Name* First Last Gender* Female Male Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Candidate Email* Candidate Phone*Student Grade level*9101112Name of High School 2024-2025*Blessed TrinityChamblee HSDunwoody HSMaristNorth Springs HSRiverwood HSSt. Pius XOtherList School hereParent Name* First Last Parent Phone*Parent Email* Emergency Contact Name* First Last Emergency Contact Phone*Media Consent*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, or Twitter) and to potentially have them in our parish bulletin or website? Names are not displayed with photos that are used in our parish media. I agree to the media policy.Please choose*Pay now and complete registrationMy family needs help with program feesPay now and complete registrationConfirmation Retreat Fee Per Child* Price: Total My family needs help with program feesPlease state why you need help with program fees*How much can you pay per child?*The minimum amount is $62.50 per candidate. All requests for reduced program fees are reviewed by the Pastor and Director of Religious Education at Saint Jude. How will you pay?*To pay by cash, you will need to come to the parish office during business hours to fill out the registration form and provide payment. Please schedule a time with Mary Kaitlyn Condict at confirmation@judeatl.com or call 770-394-3896. Credit CardCashFOR OFFICE USE ONLY – Type in code when cash is received*Total payment Confirmation Retreat* Total Credit Card InformationCredit Card*Card Details Cardholder Name Δ