Steubenville of the Rockies Registration

St. John the Baptist will be bringing a group to the Steubenville of the Rockies Conference. WHO: High School (Incoming 9th-Graduated 12th Grade) WHAT: High intensity, prayerful, youth conference aimed to equip youth to tackle the challenges of high school WHERE: Gaylord Rockies Resort WHEN: June 23rd-25th COST: $399 $199 Conference; $149 Lodging; $50 Food, Parking, and chaperone cost; Total: $399 *Scholarships Available for those who are involved in SJB Youth Group* INFO: https://archden.org/eflm/conferences-retreats/steubenville/

Email*

Secondary Email

Number of Children to Register:

Youth Info

Child 1

Child #1 Name

First Last

Child #1 Grade

Incoming 9th
Incoming 10th
Incoming 11th
Incoming 12th
Graduated Senior

Roommate Request for Child #1

Child 2

Child #2 Name

First Last

Child #2 Grade

Incoming 9th
Incoming 10th
Incoming 11th
Incoming 12th
Graduated Senior

Roommate Request for Child #2

Child 3

Child #3 Name

First Last

Child #3 Grade

Incoming 9th
Incoming 10th
Incoming 11th
Incoming 12th
Graduated Senior

Roommate Request for Child #3

Parent Info

Mother's Name

First Last

Mother's Cell Phone

Father's Name

First Last

Father's Cell Phone

Would you be willing to volunteer as a chaperone?

Yes, I'd love to help
Not this time

Would you be willing to volunteer as a driver?

Yes, I'd love to help
Not this time

Are there any severe allergies? Food allergies? Difficulties being away? Medical conditions...etc? Even hesitancy with the faith? Difficulties at home? Anything you think our group leader needs to know.

Steubenville Scholarship Fund

Small Donation - $50
Half Scholarship - $200
Full Scholarship - $400
Not at this time

Due to the location at the Gaylord, the cost of the Steubenville continues to rise. For many, this retreat is prohibitively expensiveness. If it is within your means and you feel so called, please consider donating to our scholarship fund so we can send kids who otherwise would be unable to attend.

Payment

Total

$0.00

Credit Card

Card Details

Cardholder Name