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  Mother/Daughter Program | Father/Son Program
 


Mother/Daughter Registration Form

10 - 12 year old girls

 

TBA
2 - 5 PM

St. Vincent's Medical Center, Bryan Auditorium

1851 King St., Jacksonville, FL  32204


We treat your personal information as confidential, and will release it only as might be necessary to serve you, and only to duly recognized representatives of the Diocese of St. Augustine.

Click here for more information on our Privacy Policy

Please print names as you want them to appear on name badges:


Family Information
Mother's First Name
Mother's Last Name
Mother's E-Mail Address
1st Daughter's First Name
1st Daughter's Last Name
1st Daughter's Age
1st Daughter's School
2nd Daughter's First Name
2nd Daughter's Last Name
2nd Daughter's Age
2nd Daughter's School

PLEASE NOTE:  If you have more than two daughters attending the program, please contact the Diocesan Center for Family Life for instructions.
 

Mother's Information

Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
   
Select a Payment Method VISA     MasterCard     Discover
Check     Other
  If paying by credit card, please complete requested information on the following page. 

PLEASE NOTE:  Cost is only $25/family for the mother/daughter program.
Would you like to make a donation to provide scholarship assistance to help those unable to afford the cost of registration?

Not at this time   $10  $25  $50  $75  $100

Comments:

If paying by credit card, confirmation will be sent by e-mail (if provided) or by mail.

If paying by check, confirmation will be sent by e-mail (if provided) or by mail ONLY when your check has been received. Checks should be made out to Diocesan Center for Family Life.

Any questions, please contact (904) 308-7474


    

"Let us pray...
that [families]
may be authentic communities of love and life in which the flame of faith may be handed down from generation to generation."

Pope Benedict XVI

  
 2577 Park Street    
   Jacksonville, FL 32204    
   Phone (904) 308-7474    
Copyright © 2007 Diocesan Center for Family Life                                                                                             Fax (904) 308-4087    

                                            Diocese of St. Augustine