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Summer 2021 Youth Retreat
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Parents' names Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Allergies or medications needed
- Emergency Contact Name and number Please enter valid data.
- Are you interested in being a chaperone?
- I authorize a chaperone/adult of Mater Dolorosa church to see that my child receives medical treatment that may become reasonably necessary (treatment for minor cuts and bruises, over the counter pain medication for headache, etc.)
- I authorize adults and chaperones from Mater Dolorosa Church to seek emergency medical treatment if necessary and will hold Mater Dolorosa Church and all entities harmless. I will be responsible for any fees associated with such treatment.
- Registration fee REQUIRED Please fill out this field.
- Optional processing fee
  A fee of 3% is charged to the church for using online payments. If you would like to sponsor this fee, you may do so here.
- If such an emergency occurs, parents will be contaced. If they can't be reached, the emergency contact will be called.
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