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2027 Steubenville Conference Registration

- Youth

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- Number of Students Registering REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2027/2028) REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2027/2028) REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2027/2028) REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2027/2028) REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Student 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade (2027/2028) REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Information
- Parent/Guardian 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Would you like to be considered as a chaperone for this event? REQUIRED Yes, please contact me with more information. No, I am not interested in being a chaperone. Please fill out this field.
- Parent/Guardian 2
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Phone Please enter valid data.
- Email Please enter an email address.
- Would you like to be considered as a chaperone for this event? Yes, please contact me with more information. No, I am not interested in being a chaperone.
- Consent Form/Liability Waiver
  I agree to fill out a Parental/Guardian Consent Form & Liability Waiver (link below) for each student and deliver to:
  
  Dubuque Area East Pastorate
  Attn: Steubenville Conference
  1240 Rush St.
  Dubuque, IA 52003
  
  Parental/Guardian Consent Form & Liability Waiver
  I Agree Please select this field.
- Registration Downpayment ($100/Student)
  Make your online payment below, or select "Pay Later" and deliver cash/check (payable to Dubuque Area East Pastorate) to:
  
  Dubuque Area East Pastorate
  Attn: Steubenville Conference
  1240 Rush St.
  Dubuque, IA 52003
- Downpayment (per student)100.0
- Number of Students Registering Please enter an integer (number).
Total:

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2027 Steubenville Conference Registration

Parent/Guardian Information

Parent/Guardian 1

Parent/Guardian 2

Consent Form/Liability Waiver

Registration Downpayment ($100/Student)