Agape On The Road Registration

Group Leader Name *

First

Last

Position *

Email *

Work Phone *

Cell Phone *

Parish / School *

Parish / School Address

Address Line 1

Address Line 2

City

State

Zip Code

Select the age group of your participants *

Estimated number of youth participants *

Estimated number of adult participants *

Agape Weeks - Please indicate your FIRST choice *

Agape Weeks - Please indicate your SECOND choice (copy) *

If you agree to the following terms, please respond ‘Yes’: *

I 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?

Agape On the Road Registration