Diocese of Belleville, IL

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Diocesan Youth Camp

Who:	High School Students
When:	Saturday March 16th & Sunday, March 17th, 2019
Where:	Camp Ondessonk 3760 Ondessonk Road, Ozark, Illinois 62972
Time:	5:00 pm Saturday – 6:00 pm Sunday Check-in Saturday 5:00-5:45 pm. Check-in Sunday 8:00-9:00 am (for those attending Sunday ONLY).
Cost:	$75.00 for both Saturday & Sunday $50.00 for Sunday only

The theme of this Camp is CHOSEN. This Camp is designed to help participants enter into a deeper relationship with God through youth-led talks, interactions with peers and nature, Mass, Reconciliation and other fun activities. Fee includes lodging Saturday night at the camp, food, t-shirt, and much more!

Deadline for registration is March 1, 2019

Please note: All adult chaperones must be in compliance with the Child Protection Requirements for the Diocese of Belleville.

Sponsored by the Office of Youth Ministry, Diocese of Belleville
Diocesan Youth Ministry Advisory Board (adult ministers)
Diocesan Youth Ministry Advisory Council (youth leaders)

Pay by Credit Card

Qty

Description

Amount

Total

Diocesan Youth Camp – March 16-17, 2019

$75.00

---

Diocesan Youth Camp – Sunday, March 17, 2019 only

$50.00

---

Total: $0.00

Registration Deadline: March 1, 2019
Diocese of Belleville – Office of Youth Ministry
2620 Lebanon Avenue, Building #6
Belleville, IL 62221

Person Filling Out This Information

First Name:

Last Name:

Title:

E-mail:

Phone:

Names of Those Attending

Registrant #1 First Name: *

Registrant #1 Last Name: *

Date of Birth:

Parish:

City:

Dietary Restrictions/Food Allergies:

Please check:

Adult Chaperone (includes a T-shirt)

Yes, this chaperone has completed the requirements for Child Protection compliance.

Youth (includes a T-shirt)

T-Shirt Size:

Payer 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.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *