BOLD Youth MinistryTM is a program of Fiat Ventures | | | (973) 500-3300 | P.O. Box 4005, Warren, NJ 07059

EMBOLDEN 2018 Registration Form

Fields marked with an * are required

Retreat Information

Friday, November 16 - Sunday, November 18

Camp Tecumseh, Pittstown, NJ

Cost: $150

Registration Deadline is now *EXTENDED* to November 7! Starting November 7th there will be a $25 late fee, making the cost $175 for those who register late. 

Participant Information

Parent/Guardian Information

Health and Insurance Information

Please Note: This form should disappear if successfully submitted. Please check at the TOP of the page for an error message if the form does not disappear after you submit.

You will receive a Confirmation Email once your form is successfully submitted. If you do not receive the Confirmation email within 24 hours, please check your spam folder. If you can not find the email, please contact Allison Provinsal at Please sign and return the Liability Form provided in that email to your parish office, with your registration fee of $150.

Copyright 2016 Fiat Ventures | The BOLD Youth Ministry name, logos and program are trademarks of Fiat Ventures | Unauthorized use is a violation of applicable laws. |