Two Foundations Retreat Form for Boys – Marysville – ECRC – Eastern Catholic Re-Evangelization Center

"*" indicates required fields

All fields are required to submit application.

Retreatant Information:

First name*

Last Name*

Cell #*

High School Name*

Email Address*

Birthday

Parental Information

[This portion is required for ECRC records]

Primary Parent Information

Mother or Father*

Mother

Father

Deceased

First name*

Last Name*

Cell #*

Spouse Information

Mother or Father*

Mother

Father

Deceased

Please choose the opposite choice from the one above

First name

Last Name

Cell #

Address*

Street Address City State / Province / Region ZIP / Postal Code

Two Foundations Retreat Boys

Price:

Enter Coupon Code (If any)

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

I am agreeing to the conditions and terms of the retreat shown above. Also ECRC Two Foundations retreat does have my permission to present the touching safety program to my child whose name is listed above.

First Name*

Last Name*

Last 4 of DL*