PARISH of the HOLY EUCHARIST

Holy Martyrs, Falmouth | St. Jude, Freeport
St. Gregory the Great, Gray | Sacred Heart, Yarmouth

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POTHE/OLH ACTS REGISTRATION

- Ministries

ACTS Registration
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- Welcome to the first step of registering for an ACTS Retreat or event.
  Please take some time now to fill out the form below.
  You will receive a confirmation email with in a few days.
  God Bless!
- I am signing up for the: REQUIRED Women's Retreat on November 7-10. 2024 Men's Retreat on April 24-27, 2025 Please fill out this field.
- Retreatant Contact Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name as you want it to appear on your Name Badge Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  What is your preferred means of contact? REQUIRED Email Text Message Please fill out this field.
  
  Parish & City Please enter valid data.
  
  Do you have any specific dietary, medical, physical and/or special needs that we need to be aware of (i.e. stairs, walking distances, allergic conditions such as scents, smoke, etc.)? Yes - Dietary Yes - Medical, Physical or Special Needs No - Doesn't apply
  
  If Yes, please describe Please enter valid data.
- Emergency Contact #1 Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- 2nd Family/Friend Contact Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
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Payment Methods

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