Two Foundations Girls' Retreat Registration (Chicago)

"*" indicates required fields

All fields are required to submit application.

Retreatant Information:

First name*

Last Name*

Cell #*

Email*

Birthdate*

Parental Information

[This portion is required for ECRC records]

If mother is deceased please click here

Yes

Mother's First Name*

Mother's Last Name*

Mother Cell #*

If father is deceased please click here

Yes

Father's First Name*

Father's Last Name*

Father Cell #*

Mother or Father Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Two Foundations Retreat Girls Cost*

Full Amount of $300

2 Payments of $150

Enter Coupon Code (If any)

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Terms & Conditions*

There is certain behavior and certain expectations that are encouraged on the journey. I understand that this journey is to focus on my personal relationship with God. I agree that if I am found in possession of or participating in any way with drugs or alcohol, I will be sent home immediately at my expense. I further understand that this is a Catholic Chaldean retreat and I am expected to participate in all planned meetings and activities and abide by all rules. By checking this box, I am agreeing with all terms mentioned and all my information that I completed above is true.

For the Parent/Legal Guardian ONLY

First Name*

Last Name*

Today's Date*

Two Foundations Girls’ Retreat Registration (Chicago)

Retreatant Information:

Parental Information