Steubenville 2021

Registration

Who : 9th-12th Graders | Where : Irving Convention Center Irving, TX

When : JUNE 25- 27, 2021 | Cost : $325

For more info. on Steubenville Restored Click Here

To request a Scholarship contact Mary Maldonado: youth@stphilipcc.com

In the request should be:

Name
Reason for needing scholarship
How much $ you are requesting for scholarship whether full or partial.

We do ask that you pay what you can :)

Registrant

Teen Name

First Name*

Last Name*

Parent Name

First Name*

Last Name*

Teen Phone Number

Required* --

Address

Street 1*

Street 2

City*

State*

Zip*

Parent/ Guardian Name

First Name*

Last Name*

Parent/Guardian Number

Emergency Contact

Name

First Name*

Last Name*

Phone

Required* --

Medications/Disabilities

Please list any drug or food allergies that your teen may have, as well as, medications that your teen may need to take.	Required*

Liability Waver

I agree on behalf of myself, my heirs, successors, personal representatives and assign to protect, indemnify, save, and hold harmless the Diocese of Corpus Christi, St. Philip the Apostle Catholic Church and their officers, directors, agent,s employees, or representatives associated with the Steubenville from all damages, claims, suits, expenses and payment on account of or resulting from conditions stated on or resulting from any such injury, death, or damage to property, including resulting from the negligence of the Diocese of Corpus Christi, and parish, and or their officers, directors, and employees arising from or in connection with my attending Steubenville from June 25- June 27, 2021.

List (Single Choice)
Required*

I agree

Photography Consent

I agree to being photographed on this retreat. It is okay to use photos of me alone and in a group setting for social media, presentations, future marketing, and/or just for fun from June 25-27, 2021. If you check 'I do NOT agree' in the box below, please note that YOU are in charge of making sure you are not being photographed.

List (Multiple Choice)
Required*

	I agree
	I do not agree

Payment

Shopping BasketRequired* The total cost of $325, which includes a deposit of $125 and two payments of $100. Registration will be available online as well as in the parish office.