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Home
About ACTS
ACTS Amarillo History
ACTS Patron Saint
CORE Team
FAQs
Registration
What is an ACTS Retreat?
Adult Registration
Teen Registration
Cancellations & Refunds
Community & Outreach
Give/Donate
Retreat Sponsorship
Prayer Boards
Being "Called on Team" & Volunteers
Teen Hall Monitors
Parish Reps & Small Groups
Contact ACTS
Feedback & Questions
Database Updates
Prayer Requests
Resources
Resources & Small Groups
ACTS Team Tips
Teen Registration
Register for an upcoming Teen Retreat
Make Final Payment
Print Paper Form*
*PLEASE NOTE: Online registration is faster and easier, for both the retreatant and our volunteers;
however, you may use the mail-in paper form by clicking the "Print Paper Form" button.
The maximum number of form submissions has been reached. This form is currently not available.
Select Retreat
Which Retreat are you registering for?
REQUIRED
(Select One)
Teen's Retreat December 2023
Please fill out this field.
Are you Registering as a Retreatant or Team Member?
REQUIRED
Retreatant
ACTS Team Member
Please fill out this field.
Registration Form (Part A)
Payment Verification
REQUIRED
I will pay the $100.00 deposit which leaves a balance of $100.00 owed
I will pay the $200.00 fee in full
Please fill out this field.
Email Used on Paypal
REQUIRED
Please fill out this field.
Please enter valid data.
Participant's First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Participant's Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Name teen would wish to be called by?
REQUIRED
Please fill out this field.
Please enter valid data.
Date of Birth
REQUIRED
Please fill out this field.
Please enter a date.
Address
REQUIRED
Please fill out this field.
Please enter valid data.
City
REQUIRED
Please fill out this field.
Please enter valid data.
State
REQUIRED
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Please fill out this field.
Zip
REQUIRED
Please fill out this field.
Please enter valid data.
Home Phone
REQUIRED
Please fill out this field.
Please enter valid data.
This information is required!
Teen's Email Address
REQUIRED
Please fill out this field.
Please enter valid data.
This information is required!
Teen's Phone Number
REQUIRED
Please fill out this field.
Please enter valid data.
Sex
REQUIRED
Male
Female
Please fill out this field.
Grade
REQUIRED
(Select One)
9th grade
10th grade
11th grade
12th grade
Please fill out this field.
Anticipated Graduation Year
REQUIRED
Please fill out this field.
Please enter valid data.
School
REQUIRED
Please fill out this field.
Please enter valid data.
Is participant a practicing Catholic?
REQUIRED
Yes
No
Please fill out this field.
If so, what Parish/Church?
Please enter valid data.
City of Parish/Church
Please enter valid data.
T-Shirt Size (Adult Sizes Only)
REQUIRED
(Select One)
Small
Medium
Large
X-Large
2XL
3XL
4XL
Please fill out this field.
Parent or Guardian's Name
REQUIRED
Please fill out this field.
Please enter valid data.
Parent/Guardian's Home Phone
REQUIRED
Please fill out this field.
Please enter valid data.
Parent/Guardian's Business Phone
Please enter valid data.
Parent/Guardian Cell Phone
Please enter valid data.
I,
REQUIRED
Please fill out this field.
Please enter valid data.
grant permission for my teen,
REQUIRED
Please fill out this field.
Please enter valid data.
to participate in this youth ministry event, including transportation as needed. This activity will take place under the guidance and direction of adult and youth volunteers of the ACTS Community.
REQUIRED
Please fill out this field.
Please enter valid data.
Medical Consent and Permission to Treat (Part B)
To the best of my knowledge, my teen
REQUIRED
Please fill out this field.
Please enter valid data.
is in good health, and I assume all responsibility for the health of my teen. Emergency Medical Treatment: In the event of an emergency, I hereby grant permission to transport my teen to a hospital for emergency medical treatment.
REQUIRED
Yes
No
Please fill out this field.
Preferred Hospital
REQUIRED
Please fill out this field.
Please enter valid data.
I wish to be advised prior to any further treatment by the hospital or doctor.
REQUIRED
Yes
No
Please fill out this field.
If you are unable to to reach me, please contact:
REQUIRED
Please fill out this field.
Please enter valid data.
Relationship to me or my Teen
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.
Medical Information
Insurance Carrier
REQUIRED
Please fill out this field.
Please enter valid data.
Insurance Policy Number
REQUIRED
Please fill out this field.
Please enter valid data.
My teen is taking medication and will bring all of them in their original containers
REQUIRED
Yes
No
Please fill out this field.
I hereby grant permission for non-prescription medication (such as cough drops, cough syrup, tylenol, etc.) to be given to my teen if necessary
REQUIRED
Yes
No
Please fill out this field.
I understand that asprin will not be given to my teen without express permission. I hereby grant such permission:
REQUIRED
Yes
No
Please fill out this field.
My teen is allergic to the following:
REQUIRED
Please fill out this field.
My teen's immunizations are current and up-to-date.
REQUIRED
Yes
No
Please fill out this field.
My teen's last tetanus/diphtheria immunzation was on
REQUIRED
Please fill out this field.
Please enter a date.
My teen has the following physical limitations
REQUIRED
Please fill out this field.
My teen has the following restraints: bed wetting, fainting, tics, etc.
REQUIRED
Yes
No
Please fill out this field.
If yes, please explain
My teen has recently been exposed to a contagious disease or condition such as mumps, measles, chickenpox, COVID, etc
REQUIRED
Yes
No
Please fill out this field.
If yes, please state the date and disease or condition
My teen is suffering from a psychological condition which may affect or limit his or her ability to participate in this activity.
REQUIRED
Yes
No
Please fill out this field.
If yes, please explain
Parent/Guardian Signature
REQUIRED
Please fill out this field.
Please enter valid data.
Final Payment: A deposit of $100 will guarantee your spot for the retreat. Full payment must be received on or before the date of the retreat. If only paying your deposit today, please visit our payment page to make your final payment.
Payment Type
REQUIRED
100.0
– Deposit
200.0
– Full Payment
Please fill out this field.
Payment Amount
REQUIRED
$0.00 – (Select One)
$100.00 – Deposit
$200.00 – Full Registration
Please fill out this field.
Total:
Submit
Proceed to Payment
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