Registration Form

CRHP Weekend Retreat

 

 

Weekend: (check one)     _____ Women’s      _____ Men’s

 

Name:_________________________________________________________________

 

Preferred or Nick Name:___________________________________________________

 

Street Address _________________________________________________________

 

City/State _______________________________________ Zip Code ______________

 

Phone-Day: ______________ Night: _______________ Cell: __________________

 

Email Address:__________________________________________________________

 

Please list any special physical, overnight, or dietary needs and/or requirements.  We will make every effort to accommodate these requests.

 

Emergency Contact Information (Please list 2 contacts)

 

First & Last Name_______________________________________________________

 

Relationship to you:______________________________________________________

 

Phone-Day: ________________ Night: _______________ Cell: __________________

 

First & Last Name______________________________________________________

 

Relationship to you:______________________________________________________

 

Phone-Day: ________________ Night: ________________ Cell: __________________

 

 

Registrations can be put in an envelope marked  ”CRHP” and dropped in the collection basket on Sunday, dropped off at the Parish Office during office hours, or mailed to:

 

St. Dominic Parish

CRHP Registration

4551 Delhi Rd

Cincinnati,  OH  45238