Kairos 42 Registration February 28 – March 3, 2019 Registration Deadline is February 4, 2019 Name* First Last Gender*How 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, Online Parent Permission Form, Online 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 All registration forms and payment must be received by February 4, 2019 Registration is on a first-come basis (complete registrations). If registration goes beyond capacity we will give priority to Saint Anne parishioners. We will notify you of your acceptance to the retreat a few days after registration closes. Registrations submitted after February 4, 2019 will be considered on a space-available basis only No refunds can be made after February 7, 2019 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 EmailThis field is for validation purposes and should be left unchanged.