Youth Summit 2019 Registration

Western Eparchy 2019 Youth Summit - Registration form

* Indicates required field

Name: *

Address *

Email *

Phone Number *

Age *

Children ages 8-10 must bring a parental chaperone. Chaperone is responsible for his/her own expenses.

Emergency Contact 1 (Name and Phone) *

Emergency Contact 2 (Name and Phone) *

Allergies/Dietary requirements (Please be detailed) *

Parish priest *

Parish *

Waiver Info
Please sign the waiver (link below) and upload it to this form or email it to Fr. Tim.

Waiver Upload *

Max file size: 20MB

Submit