Mountain Madness Registration

Mountain Madness 2022 Registration

For Middle School (6th-8th Grade) youth @ YMCA Estes Park on February 18th-20th, 2022.

Cost: $200 ($165 Retreat + $35 for Chaperone Costs & Food Related to Weekend) *Payment will be refunded in full if event in February is unable to happen.

Email*

Secondary email

Family last name*

Youth Info

Child #1 Name*

Child #1 Grade*

6th
7th
8th

Requested Roommate for Child #1

Child #2 Name

Child #2 Grade

6th
7th
8th

Requested Roommate for Child #2

Parent Info

Mother's name*

Mother's Cell Phone*

Father's name*

Father's Cell Phone

Would you be willing to volunteer as a chaperone?*

Yes
No

Are you willing to help us drive up leaving St. John the Baptist Parish at 3PM on Friday, February 18th and picking us up on Sunday, February 20th?*

Yes
No

Are there any severe allergies? Food allergies? Difficulties being away? Medical conditions...etc? Even hesitancy with the faith? Difficulties at home? Anything you think we should know.

Payment

Mountain Madness 2022 Fee

How many kids did you register for this event?

Price: $200.00

Mountain Madness Scholarship Donations: If you are willing, please consider donating an additional amount to sponsor part of a scholarship for someone unable to afford this opportunity by checking one of the boxes below.

Other Amount

Total

$0.00

Credit Card

Card Details

Cardholder Name

Mountain Madness 2022 Registration

Youth Info

Parent Info

Payment

Internet

Religious Education Program Info