Welcome Retreat Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Preferred Name (for name tag) REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Are you a St. Jude Parishioner? REQUIRED Yes No Please fill out this field.

Do you have a cot or air mattress? REQUIRED Yes No Please fill out this field.

Any special dietary needs? REQUIRED Yes No Please fill out this field.

Any physical limitations? REQUIRED Yes No Please fill out this field.

Which retreat are you signing up for? REQUIRED Women’s Retreat: January 15-16, 2022 Men’s Retreat: February 19-20, 2022 Please fill out this field.

If yes to either dietary restrictions or physical limitations, please explain

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergency Contact Address (if same, please indicate) Please enter valid data.

St. Jude Catholic Parish