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Middle School Retreat Registration

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Piedmont Deanery Middle School Retreat 2023
YOU NEVER LET GO | NO ME ABANDONARÁS
Sunday, November 5th, 9AM-4:30PM

Chestnut Ridge Camp and Retreat Center
4300 Camp Chestnut Ridge Rd, Efland, NC 27243

A RETREAT FOR 6TH-8TH GRADE YOUTH
UN RETIRO PARA LOS GRADOS 6, 7 Y 8

$40 per YOUTH/JOVEN; $10 for VOLUNTEER/VOLUNTARIO
If financial assistance is needed, please contact your local parish youth ministry program.
Si necesita asistencia financiera, comuníquese con el programa de ministerio juvenil de su parroquia.

Download Registration Form
Descargar Formulario de Registro
or register online below | o incribirse online a continuación
Registration Deadline | Fecha Limite de Inscripción: October 20

Click HERE to volunteer. Haga clic AQUÍ para voluntario.
Retreat Registration | Inscripción de Retiro
The maximum number of form submissions has been reached. This form is currently not available.
- Parent/Youth Group Contact Information | Información de Contacto del Padres/Grupo de Jóvenes
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parish Church | Parroquia REQUIRED Please fill out this field. Please enter valid data.
- Number of youth participants to register | Número de jóvenes participantes a inscribirse REQUIRED Please fill out this field.
  
  Participant | Partícipe 1
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 2
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 3
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 4
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 5
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 6
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 7
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 8
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 9
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
  
  Participant | Partícipe 10
  
  First Name | Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name | Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Gender | Genéro REQUIRED Please fill out this field.
  
  Grade in School Year 2023-2024 | Grado en el año escolar 2023-2024 REQUIRED Please fill out this field.
  
  Emergency Contact Name| Nombre de Contacto en Caso de Emergencia REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number | Teléfono REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Food/Medical Allergies, Special Needs or Requests | Condición Médica, Alergia, Necesidades o Peticiones Especiales
Submit

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