Mission Trip Chaperone Registration Form Mission Trip Chaperone Registration FormDates & TimesPotential Dates: June 23-29 – Nashville or Knoxville, TNMission Trip CostThe total cost of the trip is estimated at $200.00 per chaperone. Cancellation/Refund PolicyIf you must cancel your reservation, $200 of the deposit will NOT be refunded. If you cancel and you have paid for the trip, if your spot cannot be filled by May 1, 2024, you are responsible for the entire trip balance.Participant InformationChaperone's Name* First Last Cell Phone NumberEmail Address Gender* M F Are you age 25 or older?* Yes No T-Shirt Size* Small Medium Large X-Large XX-Large 3X-Large Safe Environment InformationHave you completed the Archdiocesan Safe Environment Class (Virtues)?* Yes No If yes, was it more than 5 years ago?* Yes No SignatureIn signing below and submitting your $150.00 deposit, you are financially committed to the cost of this trip, by personal payment and have read and agreed to the above Cancellation/Refund Policy.Electronic Signature* Date of Acknowledgement* MM slash DD slash YYYY Δ
