Qty
Description
Amount
Total

$165.00
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Total: $0.00
Future Commitment: $0.00

Thank You for your interest in Norbs YM, St. Norbert’s Youth Ministry program.

Please complete the below registration for:

XANTEN 15 : OVERFLOW
A HIGH SCHOOL RETREAT EXPERIENCE

January 11 – January 13
St. Mary of Providence
Elverson, PA
Youth Information
Parent Information
*please provide an email that is checked regularly.
Insurance information
Emergency Contact Information
Additional Information
If not, welcome! What parish are you from?
I am the parent or legal guardian of the above mentioned youth. By checking this box I am granting my permission for s/he to attend the Xanten Retreat from January 11-13.
By checking this box I am authorizing St. Norbert Youth Ministry and its agents (Director of Youth Ministry, adult volunteers, ministry leaders, etc.) to communicate with the above-mentioned youth through email and text messaging as outlined in the guidelines required by the Office of Child and Youth Protection.
I give permission for my child(ren)’s photo to be used (without being identified) only for the parish bulletin or web pages of St. Norbert Parish
Payer Information
A receipt will be e-mailed to this address.
Your Payment Information

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