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Junior Retreat
Hye Camp
45000 E Kings Canyon Road
Dunlap, CA 93621
April 1st - 3rd, 2022
How many tickets would you like to purchase for Junior Retreat?
*
1 Ticket ($100.00)
2 Tickets ($200.00)
3 Tickets ($300.00)
4 Tickets ($400.00)
Participant Information
Camper Information
First Name
*
Last Name
*
Gender
*
M
F
Birth Date
*
+
Phone Number
*
Email Address
*
Parish / ACYO Chapter
*
Any dietary restrictions?
*
Yes
No
What are the dietary restrictions?
*
Any allergies?
*
Yes
No
Do you take medications for your allergies? If yes, please explain.
*
Parent First Name
*
Parent Last Name
*
Parent Phone Number
*
Parent Email Address
*
2nd Participant Information
First Name
*
Last Name
*
Gender
*
M
F
Birth Date
*
+
Phone Number
*
Email Address
*
Parish / ACYO Chapter
*
Any dietary restrictions?
*
Yes
No
What are the dietary restrictions?
*
Any allergies?
*
Yes
No
Do you take medications for your allergies? If yes, please explain.
*
Parent First Name
*
Parent Last Name
*
Parent Phone Number
*
Parent Email Address
*
3rd Participant Information
First Name
*
Last Name
*
Gender
*
M
F
Birth Date
*
+
Phone Number
*
Email Address
*
Parish / ACYO Chapter
*
Any dietary restrictions?
*
Yes
No
What are the dietary restrictions?
*
Any allergies?
*
Yes
No
Do you take medications for your allergies? If yes, please explain.
*
Parent First Name
*
Parent Last Name
*
Parent Phone Number
*
Parent Email Address
*
4th Participant Information
First Name
*
Last Name
*
Gender
*
M
F
Birth Date
*
+
Phone Number
*
Email Address
*
Parish / ACYO Chapter
*
Any dietary restrictions?
*
Yes
No
What are the dietary restrictions?
*
Any allergies?
*
Yes
No
Do you take medications for your allergies? If yes, please explain.
*
Parent First Name
*
Parent Last Name
*
Parent Phone Number
*
Parent Email Address
*
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