Two Foundations Boys Private Two Foundations Retreat Form for Boys "*" indicates required fields Retreatant InformationName* First Last Cell #*Birthdate* Email Address*School Name*Do you have any food allergies? If yes, please list them. If no, please type NO.*Parental Information [This portion is required for ECRC records] MotherFirst name*Last Name*Cell #*Email* FatherFirst name*Last Name*Cell #*Email* Payment InformationAddress* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Two Foundations Retreat Boys Price: Enter Coupon Code (If any)Terms & Conditions* I agree to terms below There is certain behavior and certain expectations that are encouraged on the journey. I understand that this journey is to focus on my personal relationship with God. I agree that if I am found in possession of or participating in any way with drugs or alcohol, I will be sent home immediately at my expense. I further understand that this is a Catholic Chaldean retreat and I am expected to participate in all planned meetings and activities and abide by all rules. By checking this box, I am agreeing with all terms mentioned and all my information that I completed above is true.For the Parent/Legal Guardian ONLY* I agree to terms below By checking this box, I am agreeing with all terms mentioned above related to my child and I give full permission for them to attend the Two Foundations retreat with ECRC. *Please type your full name and today's date below to submit your consent for your child to participate in the Two Foundations Retreat.*Name* First Last Today's Date* If you would like to help ECRC cover the 3.5% credit processing fee please click YES below YES CC processing fees Price: $0.00 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Δ
