Agape On the Road Registration Agape Service Project 2022 - RegistrationPlease enable JavaScript in your browser to complete this form.Group Leader Name *FirstLastPosition *Email *Work Phone *Cell Phone *Parish / School *Parish / School AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSelect the age group of your participants *6th - 8th grade9th - 12th grade6th - 12th gradeEstimated number of youth participants *Estimated number of adult participants *Agape Weeks - Please indicate your FIRST choice *June 19-23 (group size currently limited to 12 youth) June 26-30 - Only 15 spots leftUNAVAILABLE July 5-7 (modified week due to holiday) UNAVAILABLE July 10-14 UNAVAILABLE July 17-21 July 24-28 (only 15 youth spots left)July 31-August 4 Agape Weeks - Please indicate your SECOND choice (copy) *June 19-23 (group size currently limited to 12 youth) June 26-30 - Only 15 spots leftUNAVAILABLE July 5-7 (modified week due to holiday) UNAVAILABLE July 10-14 UNAVAILABLE July 17-21 July 24-28 (only 15 youth spots left)July 31-August 4 If you agree to the following terms, please respond ‘Yes’: *NoYesI have read the registration brochure and understand the registration policies, including that upon submission of this registration form, the Archdiocese will invoice the parish for the $500 non-refundable registration fee. I have read the current COVID protocol on the registration website and understand what is expected of my group to participate (including the vaccination requirement). Do you have any questions or comments?Submit