Cycle A

- Bullying, Harassment and Conflict Management

Saturday, November 9, 2013
St. Dominic Archdiocesan Center Auditorium
10:00 a.m.
- 4:00 p.m.
All 6th - 8th grade youth
Costs: $25 per person
(includes Lunch)

Registration Deadline: October 21, 2013

After October 21st, registration becomes $40.00
Please complete the following registration form and return to your Youth Ministry Leader. Each
participant must have a liability and medical release form, accompanied by the registration form and fee.

REGISTRATION FORM
Parish Name:

Epiphany of the Lord Catholic Community

____________________________________________________________

CYM/Youth Leader:

Dave Clark
____________________________________________________________

Participant Name:

_____________________________________________________________

Status: Youth/Adult (Circle one)

Gender: _______

Grade: _________

Phone #: __________________________ Email: ______________________________

Address:_________________________________________________________________
City: __________________________________________Zip: ___________________
Do You Need a Vegetarian Meal? ________

Sponsored by the Archdiocese of Galveston

Office of Adolescent Catechesis and Evangelization

-Houston