A.C.T.S. - Diocese of Amarillo

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Online Adult Form

- Registration

Please note: Although we prefer online registration, if you need a mail in form, you can get one here.

Please complete the following form to finish your registration
for the
Adult ACTS Retreat

(All Information will be kept confidential)

For adult retreat or registration information contact Norma Frausto @ 806 -683-4623
or email: norma.frausto51@gmail.com
The maximum number of form submissions has been reached. This form is currently not available.
- Select Retreat
  
  Which Retreat REQUIRED
  Which ACTS Retreat are you registering for? Deadline to Register is the Thursday before the Retreat
  Please fill out this field.
  
  Registering as a Retreatant or Team Member? REQUIRED Retreatant ACTS Team Member Please fill out this field.
- Personal Information
  
  Payment Verification REQUIRED I have paid a $100.00 Deposit which leaves a balance of $100.00 I have paid $200.00 in Full Please fill out this field.
  
  Email Used on Paypal REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name you wish to be called by. REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter an integer (number).
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Main Contact Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Alt Phone Please enter valid data.
  
  E-Mail Address REQUIRED Please fill out this field. Please enter an email address.
- Contact Information
  
  Family Emergency Contact Person REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Contact Person REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number of Contact Person REQUIRED Please fill out this field. Please enter valid data.
- Miscellaneous
  
  ACTS Sponsor or Who introduced you to ACTS? REQUIRED Please fill out this field. Please enter valid data.
  
  What is his or her phone number? REQUIRED Please fill out this field. Please enter valid data.
  
  Are you a practicing Catholic? REQUIRED Yes No Please fill out this field.
  
  If Yes what Parish and City Please enter valid data.
  
  Protestant Yes
  
  May we publish your name on a prayer list for this retreat? REQUIRED Yes No Please fill out this field.
  
  Will you have any specific dietary or medical needs during this weekend? If Yes please enter needs here. REQUIRED Please fill out this field.
- Final Check. Please check your registration form and Submit.
  
  I hereby confirm the information on this Registration Form is correct. REQUIRED Please fill out this field. Please enter valid data.
Submit

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Thanks and God Bless!

Online Adult Form

Please note: Although we prefer online registration, if you need a mail in form, you can get one here.

Please complete the following form to finish your registration for the Adult ACTS Retreat

Please complete the following form to finish your registration
for the
Adult ACTS Retreat