_________ CM480 Jun 21 to Jun 23, 2008 _________ CM481 Jul 12 to Jul 14, 2008 _________ CM482 Aug 09 to Aug 11, 2008 _________ CM483 Oct 17 to Oct 19, 2008 _________ CM484 Nov 08 to Nov 10, 2008 _________ CM485 Nov 28 to Nov 30, 2008 _________ CM486 Dec 27 to Dec 29, 2008 _________ CM487 Jan 17 to Jan 18, 2009 _________ CM488 Feb 14 to Feb 16, 2009 _________ CM489 Mar 14 to Mar 16, 2009 _________ CM490 Apr 04 to Apr 06, 2009
*(Must have completed sophomore year in High School or be 17 or older)
Name ________________________________________ Sex___ Birthday________*Age_____ Preferred Name on Name Tag________________________ Email:_____________________ Permanent Address ____________________________________________________________ City__________________________ State _________ Zip ________ Phone ____________ Address Used During School Year ______________________________________________ City__________________________ State _________ Zip ________ Phone ____________ Marital Status ________________________ Spouse's Name ________________________ Religion___________________ School__________________________ Grad Year________ Parish___________________________________ Pastor______________________________ Parish Address______________________________ City__________ State___ Zip _____ Parent's Name_________________________________________________________________ Do you have any health or physical needs? ____________________________________ How did you find out about TEC? (Please use specific names) _________________________________________________ Total cost of weekend is $65. Please attach a non-refundable $30 registration deposit and mail this form to Central Minnesota TEC, PO Box 500, 104 Crosier Dr. N, Onamia, MN 56359. Phone 320-532-4455, Fax 320-532-4459. Weekends are held in Little Falls, MN. Phone during a weekend 320-632-1675.
If you are a student living at home, please ask your parent or guardian to sign this application and medical waiver. In case of illness or injury, I authorize those in charge of the TEC weekend that my son or daughter attends, to obtain whatever medial assistance that seems necessary for his or her well being.
Signed by ___________________________________ Phone: _____________________