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Steubenville Youth Conference July 7-9, 2023
Registration Form
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  Student Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Birth date: REQUIRED Please fill out this field. Please enter valid data.
  
  Cell # REQUIRED Please fill out this field. Please enter valid data.
  
  Address: REQUIRED Please fill out this field. Please enter valid data.
  
  City: REQUIRED Please fill out this field. Please enter valid data.
  
  Postal Code: REQUIRED Please fill out this field. Please enter valid data.
  
  T-shirt Size REQUIRED Please fill out this field.
  
  Name of Parent(s)/Legal Guardian(s): REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent Cell # REQUIRED Please fill out this field. Please enter valid data.
  
  Registration Cost: $250 (Includes conference cost, accomodations, 6 meals, transportation and t-shirt) REQUIRED Interac e-Transfer (instructions found below) Drop off at Parish Office: cash or cheque made out to 'Holy Redeemer Parish Cluster' Please fill out this field.
  
  INTERAC E-TRANSFER INSTRUCTIONS
  
  Log into your online bank account
  
  Select Interac e-Transfer
  
  Select what account you are sending money from
  
  Complete the email address section of the recipient ([email protected])
  
  Select your payment amount of $250 (Please enter 'Steubenville payment/att: Cathy Kennedy' in the message section)
  
  Your payment will be automatically deposited without any need of security confirmations as our account is registered for auto deposits.
  
  I grant permission to use photographs and/or video taken of my child during the Steubenville trip in publications, and in other online communications related to the mission of promoting ministry by our parish. REQUIRED Yes No Please fill out this field.
  
  Parish Liability Release
  
  As their parent or guardian, I give my child permission to participate in all of the activities at the Steubenville Conference that takes place at the Steubenville University in Ohio, on the weekend of July 7-9, 2023.
  
  If you have any questions or concerns, please email Dorothy deBakker [email protected]
  
  Virtual Signature (Parent Name): REQUIRED Please fill out this field. Please enter valid data.
  
  Date: REQUIRED Please fill out this field. Please enter valid data.
  
  Submit
  
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Kent Lambton Roman Catholic Family of Parishes

sT. mICHAEL cHURCH

Sacred Heart Church

Holy Family Church

Our Lady Help of Christians Church

Steubenville Youth Conference July 7-9, 2023
Registration Form