Annual Diocesan Rally Group Registration Form

Sat, November 19, 2011 Rivier Academy, Prince Albert, SK

An adult chaperone must be registered with a maximum of 10 children/youth (1 adult per 10 ratio). $30 per person / $115 per family of 4 received before Friday, November 14, 2011 $5 per person late fee if received between November 15 - 19, 2011 Registration fee includes: admission to Saturday activities, lunch, snacks, and supper o Total payment must accompany this form. o Refunds must be requested in writing before Tuesday, November 17, 2011. o There will be a $5 per person processing fee for refunds.

Please make ONE Cheque payable to: RC Diocese of Prince Albert" Mail to: Diocesan Rally 2011 1415 4 Ave West Prince Albert SK S6V 5H1

PLEASE PRINT CLEARLY! Incomplete or illegible forms cannot be processed

Group Name:
(Please indicate if you are Parish, School or independent group)

City: E-mail / Fax:

Child/Youth Registration Form Attached?

Contact Person:
Last Name
(list all family members consecutively)

Tel:
Child/Youth Health Information Retained with parish leader?
Family Group#

First Name

M/F

F1, F2, etc.

Amount Paid

1 2 3 4 5 6 7 8
Registration Checklist: REGISTER EARLY!! THIS EVENT FILLS UP VERY QUICKLY! Completed Group Registration Form(s) copy extra sheets if needed ALL Registration Forms (for youth and chaperones) Health Forms kept with leader Full payment (please send 1 cheque for your group payable to RC Diocese of Prince Albert) Copy this page if more space is required

$ $ $ $ $ $ $ $

Total amount paid and enclosed with form(s): $

For Youth Ministry Office use only:

Date Received:

Paid:

Csh Chq#

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