John Paul II Centre on Fatherhood

Presents
A dynamic, reconciliation experience for parents and teens

Please Understand Me
Saturday April 21st, 28th, & May 5th
(9:00am 4:00pm)
#1 HENRY PIERRE STREET, MUCURAPO ROAD,
ST. JAMES, PORT OF SPAIN

Registration Form
Registration fee (Includes Lunch & Materials): TTD$375.00 (1 Parent and 1 teenager)
Additional Registration: $150.00 (Per additional parent or teenager)
Please complete and return to JPII Centre or email us at ctccommunity@gmail.com

----------------------------------------------------------------------------------------Parents Name: __________________________________________________

Age: ________

Teenagers Name: ________________________________________________

Age: ________

Additional Parent/Teen: __________________________________________

Age: ________

Address: _______________________________________________________________________
______________________________________________________________________________
Parents Contact: Home.....

Cell

Work..

E-mail ..

Occupation...

Teenager s Contact: Home.....

Cell

E-mail ..

Occupation...

Work..

Additional Parent/Teens
Contact:

Home.......

E-mail ..

Parent Dietary Considerations:

Teenager Dietary Considerations:
Method of Payment:

Meat:
Meat:
Cash:

Cell

Work..

Occupation...

Vegetarian:
Vegetarian:
Cheque:

Other.
Other.
Bank Draft

NB: Please make all cheques payable to CTC Community, and walk with copy of bank draft
Registration spaces are limited and are only confirmed when reg. fees are paid in full. Fees are nonrefundable after registration closes on Thursday 19th April, 2012.