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Teen Encounter
Name: _____________________________________________ Date: __________
Age: ________ Date of
Birth:__________________ Male:___ Female:____
Address: ___________________________________ Phone
number: ____________
Postal Code: _________________ E-mail:____________________________________
Parish:______________________________ Pastor:_____________________________
Father's Name:_______________________ Address:____________________________
Mother's Name:_______________________ Address:____________________________
Guardianship: ____________________________________________________________
State of Health / Physical Disabilities:
_________________________________________________________________________
To be considered for a Teen Encounter Weekend, applicants must
be sixteen years old.
A fee of $60.00 is suggested to cover the cost of food,
accomodations, etc. Those unable to afford this fee will be
asked only to pay what they can. More details regarding this
fee, dates and times will be included in a follow-up letter to those
applicants whom we are able to accept for the upcoming weekend.
Applicant Signature: ________________________________________________________
Parent's Signature: ______________________________________ Date:_______________
Mail application to:
Teen Encounter
Lowell and Cathy Croken
1347 Loyalist Road
RR#2
North Wiltshire, PE C0A 1Y0
Phone: (902)566-3800
E-mail: crokens@pei.sympatico.ca
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