Saint Anne
Catholic Church

Richmond Hill, Georgia

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CYM Poland Trip Registration

- Forms

Saint Anne Catholic Youth Ministry is sponsoring a youth pilgrimage to Poland with Father Dawid, July 7-15, 2025.
Registered members of our parish's youth ministry in 8th-12th grade may sign up for this trip using this form. Total cost of the trip is $2000 per youth. Payments may be may in full or in 4 installments of $500. Online payments include a 3.1% credit processing fee.
Please contact Kathy Zdunich (stannecym@gmail.com) for more information on this trip.
This form is not accepting responses at this time.
- Parent / Guardian Information
- 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Youth Information
- Number of Youth You Are Registering REQUIRED
  15 remaining
  Please fill out this field.
  
  Youth 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions or Allergies (Note in Comments) REQUIRED Please fill out this field.
  
  Comments Please enter valid data.
  
  Payment REQUIRED 515.5 – Partial Payment - 4 Installments Required 2062.0 – Full Payment Please fill out this field.
  
  Youth 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions or Allergies (Note in Comments) REQUIRED Please fill out this field.
  
  Comments Please enter valid data.
  
  Payment REQUIRED 515.5 – Partial Payment - 4 Installments Required 2062.0 – Full Payment Please fill out this field.
  
  Youth 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions or Allergies (Note in Comments) REQUIRED Please fill out this field.
  
  Comments Please enter valid data.
  
  Payment REQUIRED 515.5 – Partial Payment - 4 Installments Required 2062.0 – Full Payment Please fill out this field.
  
  Youth 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.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions or Allergies (Note in Comments) REQUIRED Please fill out this field.
  
  Comments Please enter valid data.
  
  Payment REQUIRED 515.5 – Partial Payment - 4 Installments Required 2062.0 – Full Payment Please fill out this field.
- I understand that in order for my youth to participate in this trip, a valid passport, as well as a signed permission form and code of conduct (links in the document section below) will required prior to travel.
  
  I agree that if my youth does not abide by the conditions set forth in these documents during the trip, I may be called to pick them up early at my own expense.
  I Agree Please select this field.
Total:

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