REGISTRATION FORM: Wonderfully Made February 2025

January 31 - February 2, 2025 | St. Mary of Providence
227 Isabella Rd, Elverson, PA 19520
Cost:
EARLY BIRD PRICING
$175 per person until 12/31/24
$200 per person beginning 1/1/25
(scholarships available)

Participant Information

Name of Retreatant/Chaperone

Date of Birth (Chaperones may enter January 1, 2025)

Home Address

Grade in School

Please select one option.

8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Chaperone

Name of School/City/State (Chaperones may enter N/A)

Name of Parish/City/State

Have you attended a Wonderfully Made retreat before?

Please select one option.

Yes No

How did you hear about the retreat?

Emergency Contacts

Parent/Guardian (Emergency Contact) Name

Relationship to Retreatant/Chaperone

Parent/Guardian (Emergency Contact) Email

This address will receive a confirmation email

Parent/Guardian (Emergency Contact) Cell Number

Secondary Emergency Contact Name

Second Contact Relationship to Retreatant/Chaperone

Secondary Emergency Contact Email

This address will receive a confirmation email

Secondary Emergency Contact Cell Number

Housing

Girls will stay in the Dalton House which is double occupancy rooms. Please do not leave roommate requests on this form. We will contact you prior to the retreat for any roommate requests.

Note: Single occupancy rooms are not available.

Other Information

List any allergies.

List any conditions we should know about the retreatant/chaperone.

Photographs or videos taken during the events of the weekend may be used for future use to promote similar events. Please indicate whether you (if over 18) or your daughter may be included:

Please select one option.

I agree I disagree

Payment

$175 per person until 12/31/24; $200 per person beginning 1/1/25

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

January 31 - February 2, 2025

St. Mary of Providence
227 Isabella Rd, Elverson, PA 19520
Cost:
EARLY BIRD PRICING
$175 per person until 12/31/24
$200 per person beginning 1/1/25
(scholarships available)

REGISTRATION FORM: Wonderfully Made February 2025

Description

Please Fix the Following