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TECite Registration

Applications are due TWO weeks prior to scheduled weekend.

TEC # I wish to attend (e.g., 250): *

First Name *

Middle Name

Last Name *

Birth Date: *

format (mm/dd/yyyy)

Age *

Gender: *

male

female

Permanent Mailing Address: *

Country

City

State

Zip code

School or Alternate Address?

I have a temporary or school address?:

School Address:

Country

City

State

Zip code

Phone Number: *

format: (555)555-5555

Email Address: *

Email Address (verify): *

Religious Denomination: *

Parish Name: *

Parish City *

Parents' Names: *

School: *

Who told you about TEC:

Please answer the following questions:

Have you made other retreats?

Yes

Musical instrument(s) I play:

guitar

Piano/keyboard

none

Which term better describes your relationship with others?

quiet

talkative

Are you coming to TEC in preparation for Confirmation?

yes

My feelings about attending TEC?

1 (excited

4 (don't want to come)

Medical Release

In case of illness or injury, I do hereby give permission to obtain whatever medical assistance deemed necessary in a medical emergency while participating on the Riverbend TEC retreat indicated above. The directors of the weekend will attempt to contact the parent/guardian or designated person first before taking any needed action. The directors of this weekend have my permission to act as my agent in my absence.

Under 18, please provide parent or guardian contact information:

Adult (18 and over), please provide emergency contact information:

Contact First Name: *

Contact Last Name: *

Contact Relationship to Me?: *

Contact Phone: *

Contact Work Phone:

Pictures of my child/legal dependent taken during event may be used in print or electronic media to publicize future TEC events, unless I indicate to the Riverbend TEC Coordinator in writing to the contrary.

Acceptance of Terms: *

I accept the terms contained within this application!

I do not accept the terms contained within this application!

If you do not accept the terms of this application please contact Riverbend TEC!

Verification *

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TEC Registration

Printable registration

Online registration

TECite Registration