Fearless Retreat Confirmation Class Data Form

PARISH NAME (No abbreviations) *

Parish Street Address *

Parish City *

Parish State *

Parish Contact Person *

Parish Contact Email Address *

Contact Phone Number *

Pastor's Name *

Select the retreat for which you would like to register your group. (PLEASE NOTE: space is limited per retreat for groups. We will do our best to accommodate your request, but Confirmation Classes are registered on a first come, first serve basis. If we are unable to reserve your space, we will notify you as soon as possible with other options.) *

In the fields below, please list the names of your students, FIRST NAME, LAST NAME. Click the green (+) to add a new name. Please note that students are ALSO required to register with their parents/guardians online at www.fearlessretreats.com. Their registrations will NOT be confirmed until they have registered online as individuals. This step is required so that we have accurate family contact and medical history information.) *