Steubenville Dates: July 16-18, 2021

Reservations are due no later than midnight on March 17th along with a $52 required deposit. Please use the form to the right to register and submit payment.

Costs

$215 + Travel Expenses

$215 includes Dorm Room House, Programming, 5 meals, 2 Group T-shirts

Travel Expenses TBD based on the number of teens and chaperons going. Right now travel cost are estimated between $40 and $55

You can apply for a Scholarship for financial assistance, find it online at steubystl.com

Steuby PDF – COVID and Detailed Information

REGISTRATION

The form below will allow you to register your youth and make the down payment. You will need to submit separate forms for each teen.

2021 Steubenville Registration and Payment

Youth Information

First Name *

Last Name *

Youth Cell Phone

Youth Email

Gender *

Male

Female

Age *

Home Parish *

T-Shirt Size *

Does your youth have any unusual dietary requirements, medical history, medication, or major allergies? If yes, please indicate below:

Adult Information

Parent / Guardian / Emergency Contact (adult over 21)

Parent First Name *

Parent Last Name *

Phone *

Email *

Address *

Address

City

State/Province

Zip/Postal

Country

Secondary Adult Name (optional)

Phone (optional)

Email (optional)

Consent

CHECK THE BOX BELOW *

I hereby authorize my son/daughter to attend the Steubenville weekend. In case of emergency, I/we give permission to the attending, supervising adult from Good Shepherd Parish and/or Steubenville Organizer to seek emergency treatment for my child.

Signature *

Clear

Date Signed *

Printed Name of Parent or Guardian *