Ascension Catholic Church

Bastrop, Texas

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ACTS Registration Form

- Retreat Registration Form
  
  Retreat Attendee Information
  
  This form is not accepting responses at this time.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Name/Nickname: 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
  
  Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  Subscribe to message from Ascension
  
  Are you 21 years or older? REQUIRED Please fill out this field.
  
  Have you ever attended an ACTS retreat? REQUIRED Please fill out this field.
  
  If Yes, where? Please enter valid data.
  
  Emergency Contact
  
  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 to You REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED
  
  Please fill out this field. Please enter a phone number.
  
  PLEASE NOTE THAT THERE IS NO ALCOHOL ALLOWED ON THE ACTS RETREAT
  
  Do you have any allergies or special dietary needs? REQUIRED Please fill out this field. Please enter valid data.
  
  Do you have any medical or physical needs (i.e. assistance with walking, CPAP machine, etc.)? REQUIRED Please fill out this field. Please enter valid data.
  
  Do you have any special needs for retreat weekend? REQUIRED Please fill out this field. Please enter valid data.
  
  Are you a Parishioner of this Parish? REQUIRED Please fill out this field.
  
  If “NO”, what parish or church do you attend: Please enter valid data.
  
  Religion: Please enter valid data.
  
  Person inviting you to this retreat (if applicable): REQUIRED Please fill out this field. Please enter valid data.
  
  Submit Application Below
  Then Proceed to Payment if Paying Online
  
  Submit Application Here First
- Make Payment
  
  Men's Retreat Payment Form Womens Retreat Payment Form