Diocesan Eucharistic Congress Registration

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Inscripciones al Congreso Eucarístico Diocesano en Español AQUÍ

Pastorate Group Registrations: If your pastorate prefers to register and pay as a group, please use this form and email to Claudia Castillo ccastillo@dol-in.org
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Address REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Pastorate/Parish REQUIRED Please fill out this field. Please enter valid data.
Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff 18.0 – Lay-Person 18.0 – Youth Track (Ages 13-17) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Additional Family Members REQUIRED Please fill out this field.
- Family Member 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 6
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 7
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 8
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 9
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 10
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 11
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
- Family Member 12
  - 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.
  - Dietary Restrictions REQUIRED Please fill out this field. Please enter valid data.
  - Category REQUIRED 0.0 – Clergy 12.0 – Parish Staff (Adult Track 18+ years) 18.0 – Lay-Person (Adult Track 18+ years) 18.0 – Youth Track (Ages 13-17) 18.0 – Child (Ages 9-12) 5.0 – Childcare (Ages 3-8) Please fill out this field.
I grant permission for my minor children to participate in this event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of diocesan employees and/or volunteers from the Diocese of Lafayette-in-Indiana. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Diocese of Lafayette-in-Indiana, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith. I agree to compensate the Diocese of Lafayette-in-Indiana, its employees and agents and chaperones, or representative associated with the event, for reasonable attorney’s fees and expenses which may incur any action brought against them as a result of such injury or damage unless such claim arises from the negligence of the parish/diocese.

In the event of an emergency, I hereby give my permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact the listed Emergency Contact included above.

I grant to the Diocese of Lafayette-in-Indiana the right, privilege and license to use the picture or likeness of me and/or my child in any photograph, movie, video production or any other forms of media publication and to use the verbal or written statements or declarations of me and/or my child for the purpose of publicizing, fostering and promoting the diocese and its programs, or for any other purpose in furtherance of the mission of the Diocese of Lafayette-in-Indiana.

I understand that refund requests must be made by April 21.
I Understand and Agree Please select this field.

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