Fearless Ministries 2018 Sacred Heart Center, Vineland, NJ Youth Participant Registration Form
Registrant First Name
Registrant Last Name
Date of Birth
Current Grade (as of January 2018): Please note that the retreat is for participants in 8th-12th grades.
Please list the name of the adult chaperone accompanying your group here: (If unknown, or you are not with a parish group write "unknown" and we will contact you):
Parent or Guardian name(s):
Primary phone (or parent's phone if under 18):
Alternative phone 1
Primary e-mail (must list parent's email if under 18):
Verify email address
Note: An e-mail will be sent to this primary (or parent) e-mail from
to confirm your registration and send additional information as needed.
March 16-18, 2018, Sacred Heart Center, Vineland, NJ
Parish (or youth group) name: (No abbreviations please)
Form Login Account (optional)
New Users / Returning Users
to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.