Registration Form
When: Friday, November 12 @7:30 pm through Sunday, November 14th @4pm Our Lady of Lourdes Young Adult

Retreat Ages of 18-35

Where:  10300 SW 167th Ave, Miami, FL 33196

Cost: $125.00 pp (includes accommodations, meals, and retreat materials)

Contacts: Anagabriella Guerra @ (786) 832-9416 / aners1996@gmail.com 
Cynthia Blanco @ (786) 457-5202 / cynthiablanco28@hotmail.com
Sign in to Google to save your progress. Learn more
Full Name: *
Full Home Address: *
DOB *
MM
/
DD
/
YYYY
Phone No *
Email *
Age: *
Status: *
Parish: *
What brings you to this retreat? *
Emergency Contact: *
Emergency Contact Phone No. *
Health Status (list any restrictions):
Shirt Size: *
Payment Information
Payment Amount:
Payment Method
Clear selection
Credit Card No.
Billing Address
Exp date
The undersign grants permission to Our Lady of Lourdes Catholic Church to charge on my credit card a one time fee the total amount of $125.00 as registration fee for the Jump 2021 Young Adult Retreat.   PLEASE TYPE YOUR NAME IF YOU AGREE
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms