Quo Vadis Days

Archdiocese of Portland
Registration
August 2-5, 2010

It is very important that you fill out this form entirely,
esp. the *REQUIRED FIELDS!

**Under "YOUR EMAIL", be sure to enter a good email address,
as this is where a confirmation email will be sent!

*Full Name:
**YOUR EMAIL:
Email Subject:
*Street Address:
*City:
*State:
*Zip Code :
*Phone Number:
*Your Parish:
*City of Parish:
Pastor :
School:
Grade Entering:
*Age:
*Birthdate:
*T-Shirt Size:
*Parent/Guardian Day Phone:
Parent/Guardian Evening Phone:

Health History
Allergies (food, drugs, insects, etc.): Other information (injuries, special needs, etc.)

Is your son in general good health and able to participate in all normal youth activites? Yes No Please explain limitations:
In Case of Emergency, Contact:
*Name:
*Phone:

Comments:

Be patient! Sometimes this takes several seconds.

You need only to press "Submit to Father Cihak" once.

If you are not sure it went through, check the email account you entered at the top of this page (2nd line).

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