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Feb. 27 Registration

- The maximum number of form submissions has been reached. This form is currently not available.
  
  This is your application for the Antioch weekend.
  
  The cost of the retreat is $60.00.
  
  The first 50 registrations received will be registered for the retreat. The next 10 will be waitlisted. Payment is required with this registration.
  
  IMPORTANT --The application must be filled out and returned with the fee in order to be accepted as a candidate for the weekend. All 10th graders must participate in an Antioch Retreat prior to Confirmation next fall and must be present for the entire retreat.
  
  Anne Marie Gisoldi, Director of Youth Ministry
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  School, Grade, and Age REQUIRED Please fill out this field. Please enter valid data.
  
  Medical/Psychological Concerrns Please enter valid data.
  
  Medication being taken Please enter valid data.
  
  Allergies we need to know about Please enter valid data.
  
  If you are interested: Parents sometimes donate food for the retreat. Individual packaged desserts - bring when you come Individual packaged snacks: pretzels, chips, etc. Bring when you come Cans of Soda or bottles of water
  
  Cost of Retreat60.0
  
  Total:
  
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St. Vincent Martyr

26 GREEN VILLAGE ROAD
Madison, NJ 07940

973-377qaqqq-4000

Gifted • Grateful • Giving • Growing

Feb. 27 Registration