2024-2025 PARENT / GUARDIAN / PARENT-FIGURE/SON RETREAT

February 15-16, 2025
Jesuit Retreat Center, Los Altos
$300 Per Family

Financial Aid Available Upon Request

Student's Last Name*

Last Name

Student's First Name*

First Name

Student De La Salle Email*

12345@dlshs.org

Grade Level*

9101112

Student's Nutritional Preference*

No PreferenceVegetarianVeganGluten Free

Student's Food Allergies. If none, please type N/A*

Does Parent / Guardian / Parent-Figure need translation? If so, into what language?

Does Parent / Guardian / Parent-Figure have access to a computer?*

YesNo

Can Parent / Guardian / Parent-Figure use a computer without the help of the student who is registering?*

YesNo

Parent / Guardian / Parent-Figure's Last Name*

Last Name

Parent / Guardian / Parent-Figure's First Name*

First Name

Parent / Guardian / Parent-Figure's Relationship to Student Registering *

(e.g., Mother; Father; Step-Mother; Step-Father; Guardian; Grandmother, etc...)

Parent / Guardian / Parent-Figure Phone Number*

Area CodePhone Number

Parent / Guardian / Parent-Figure Email*

Confirmation email will be sent to this address.

Parent / Guardian / Parent-Figure's Nutritional Preference*

No PreferenceVegetarianVeganGluten Free

Parent / Guardian / Parent-Figure's Food Allergies. If none, please type N/A.*

Registration Fee $300 Per Family -- PLEASE NO AMERICAN EXPRESS OR DISCOVER CARD. Payment needs to be received prior to the Retreat. -- Financial Aid is Available Upon Request.*

PARENT / GUARDIAN / PARENT-FIGURE Retreat

$300.00

	Quantity	Price
Retreat (Enter the number 1)		$300.00
Donation - Optional (Enter the amount you would like to donate.) Thank you for your donation!		$1.00

Item subtotal:$0.00

Financial Aid Requested - If requesting Financial Aid, you do not need to fill out the billing address section.Campus Ministry will contact you. No payment is necessary at this moment to register. If this option is chosen, please let us know why you are requesting financial aid by filling out the question below regarding Financial Aid.

$ Free

Total

$0.00

Credit Card (Visa or Master Card Only - Please No American Express or Discover Card)

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

If you are requesting Financial Aid, and receive less than 50% in Financial Aid from DLS, or if your son is not a member of the Bishop Cummins community, please let us know in a brief paragraph why you are requesting Financial Aid. Thank you!

If you need to cancel, please contact the Campus Ministry office at 925-288-8185 as soon as possible. Refund is available only if cancellation is made 30 or more days prior to the retreat date.

Please verify that you are human*

2024-2025 PARENT / GUARDIAN / PARENT-FIGURE RETREAT