Catholic Charismatic Renewal Youth Outreach

Pentecost Retreat

For Young People

Registration Form

Date: ___________________

Name: ____________________________________________

Address: __________________________________________

City: __________________  State: _________ Zip Code: ______________

Age: _____________     Grade in School: ______  Male/Female:  ________

Parish: ______________________________________

Role (Participant, chaperone, youth leader, parent, etc.):   ______________

Have you attended a Life in the Spirit retreat before:  __________

If so, where and when: _____________________________________

Special Needs (diet, etc.): _______________________________________

Parental Signature if under 18: _____________________________________

           Print name: _______________________________________________

Please include $35 for registration. 

Make checks out to:

Jane Barz

Mail registration form to:

Kathleen Darling  - 46775 266^th St.  - Sioux Falls, SD    57106