Diocese of Sioux City

Looks like you're using Safari! To complete your transaction you'll need to open the form in a new tab. Click the button below to continue.

This Form is in Test Mode

This form is not ready to process live transactions.

YOUR TRANSACTION DATA WILL NOT BE SAVED.

*** If you feel you are getting this message in error, please check
with the administrator of the site that sent you to this form. ***

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for Rekindle 2023. We look forward to seeing you on Saturday, March 25th at Kuemper High School in Carroll, IA! Visit www.scdiocese.org/rekindle for more information and the schedule.

Registration

Qty

Description

Amount

Total

Student(s)

$45.00

---

Adult(s)

$15.00

---

Total: $0.00

You, as the group leader, are responsible for collecting a consent and liability waiver from each participant attending, youth and adult. Mail forms to the Office of Evangelization Attn: Kara Kardell by March 21st or turn forms in at check-in on the day of the event. Participants CANNOT stay without this form. Visit the diocesan Rekindle page to download all forms.

Student & Adult Registrant Information

Students in 7-8th grade:

Please indicate number of students registered above in 7-8th grade

Students in 9-12th grade:

Please indicate number of students registered above in 9-12th grade

Adult Chaperones:

Please indicate number of adults chaperones registered above. Note: 1 adult for every 8 students is required.

Group Leader Information

Group Leader Name: *

(leader attending the event)

Phone Number:

Email:

I have read:

Parish Leader Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Parish:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *