Kairos 39 Registration Name* First Last Gender*MaleFemaleHow would you like your name to appear on your name tag?*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Student Cell Phone*Student E-mail* School*Grade*Age*Are you a member of St. Anne?*YesNoIf you belong to another parish or church community, which one?*Mother's Name* First Last Mother's Cell Phone*Mother's Email* Father's Name* First Last Father's Cell Phone*Father's Email* Important: Please watch your email for retreat details as your child’s retreat date draws closer. Online Registration, Parent Permission Form, Teen Participant Agreement Form, and your payment of $350.00, must be received in order for your registration to be complete. Make checks payable to Saint Anne Youth Ministry Forms and check can be mailed to Saint Anne Youth Ministry 120 North Ela Street, Barrington, IL 60010 All registration forms and payment must be received by October 23, 2017 Registration is on a first-come basis (complete registrations). If registration goes beyond capacity we will give priority to Saint Anne parishioners. Registrations submitted after October 23, 2017 will be considered on a space-available basis only No refunds can be made after October 26, 2017 NO EXCEPTIONS Questions? Please contact Michael Hugo at 847-620-3073 or at firstname.lastname@example.org or Karen Poglitsch at 847-620-3072 or at email@example.com Please upload a current photo of yourself*Accepted file types: jpg, png.PhoneThis field is for validation purposes and should be left unchanged.