Steubenville 2020

Registration

Who : 8th-12th Graders | Where : Randolph Riverfront Center Alexandria, LA

When : JUNE 26 - 28, 2020 | Cost : $300

For more info. on Steubenville RESTORE Click Here

To request a Scholarship contact Fr. Alfredo Villareal: pastor@stphilipcc.com

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

Medications/Disabilities

Please list any allergies, including food allergies, if your teen has any. As well as medications that your teen may need to take.

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 26- June 28, 2020.

List (Single Choice)

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 26-28, 2020. 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)

	I agree
	I do not agree

Payment

Shopping Basket The total cost of $300. Consisting of a Deposit of $100 and two payments of $100. Registration will be available online as well as in the parish office.