Emmaus Conference Online Registration Form

Emmaus Conference Online Registration

Please fill in the form below. If you are registering multiple people, select "Add Participant/Child for Childcare."
Registration Type:
- Adult Participant: Anyone over the age of 18 and who is out of high school, including college students, attending the conference.
- Youth Participant: Any teenager 6-12th grade who wish to attend the conference.
- Youth for Childcare: Childcare will be available at the Emmaus Conference for children, ages 3-10 years old.
During the conference, meals will be provided by Nelson's Port-a-Pit. Meal options include:
- Chicken Lunch Buffet (Includes choice of grilled chicken, pulled pork, or hot dogs; naturally dairy free and gluten free)
- Kid meals (chicken meal)
- Vegetarian meal (veggie burger sandwich)
- Vegan meal (portobello mushroom caps w/balsamic glaze)
Registration*
Parent/Legal Guardian Information for Youth Participants
Additional Youth Participant Information*
Parent/Legal Guardian Name*

First NameLast Name
Parent/Legal Guardian Email Address*
example@example.com
Parent/Legal Guardian Phone Number*
Please enter a valid phone number.
I understand that I (parent or legal guardian) will need to complete a waiver for my child to participate in the Emmaus Conference.*

YesNo
I understand that all youths need to be accompanied by an adult (over the age of 21) chaperone. If it is another adult, such as a youth minister or teacher, they need to be in compliance of the Diocese of Gary's Safe Environment Policy. My child's chaperon will be*

Me, the parent/legal guardianAnother Adult
Name of Chaperone*

First NameLast Name
Chaperone Email Address*
example@example.com
Chaperone Phone Number*
Please enter a valid phone number.
Relationship to Youth (such as youth minister, aunt/uncle, teacher)*
Parent/Legal Guardian Information for Children attending Childcare
Children to attend childcare*
Parent/Legal guardian name that will drop child at childcare*

First NameLast Name
Parent/Legal Guardian Email Address*
example@example.com
Parent/Legal Guardian Phone Number*
Please enter a valid phone number.
I understand that I (parent or legal guardian) will need to complete a waiver for my child to participate in the Emmaus Conference.*

YesNo
Name of any other authorized adult that can pick up or check in on child in childcare. (Such as the other parent or legal guardian or a trusted family member)

First NameLast Name
Other Adult's Email Address
example@example.com
Other Adult's Phone Number
Please enter a valid phone number.
Relationship to Youth (such as parent, aunt/uncle, grandparent).

There are two options for payment: pay online or pay by cash or check. Please note, that we cannot guarentee registration until payment is complete.
Payment options

Pay via Cash or CheckPay Online

Pay via Cash or Check
Payee's Name*

First NameLast Name
Number of Adult Participants*
Number of Student Participants
Middle school, high school, and college students
Number of Children for Childcare
Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Thank you for completing the registration!

The cost for the program is $75 per participant.

Students (middle school, high school, and college) are $25 per participant.

Childcare is $20 per child up to three children. If registering more than three children, the flat rate is $60 per family.

Payment is due within three weeks of registering online. After three weeks, we cannot guarentee that we can hold your tickets.

Checks can be made out to "Diocese of Gary." Please put "Emmaus Conference" in the memo.

Checks or cash can be mailed to:

Attn: Emmaus Conference
Diocese of Gary
9292 Broadway
Merrillville, IN 46410

You can also drop off checks or cash to the Diocese of Gary Pastoral Center, (9292 Broadway, Merrillville, IN) Monday - Friday, from 8:30 AM - 4:30 PM.

If you have any questions regarding registration or payment, please contact Vicky Hathaway at 219-769-9292 ext. 88229 or at vhathaway@dcgary.org.

Pay Online

Please enter the details of the individual responsible for payment below.
Thank you for completing the registration!

The cost for the program is $75 per participant.

Students (middle school, high school, and college) are $25 per participant.

Childcare is $20 per child up to three children. If registering more than three children, the flat rate is $60 per family.

Payment is due at time of checkout.

If you have any questions regarding registration or payment, please contact Vicky Hathaway at 219-769-9292 ext. 88229 or at vhathaway@dcgary.org.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

My Products

Adult Participant

$75.00 # of participants

Student Participant Middle school, high school, and college students

$25.00 # of students

Child for Childcare

$20.00 # of children

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Once you click submit, you will be registered for the Emmaus Confernece!
As we get closer to the date, you will receive updates for the event. We look forward to experiencing this conference with you!
Should be Empty:

Emmaus Conference Online Registration

Parent/Legal Guardian Information for Youth Participants

Parent/Legal Guardian Information for Children attending Childcare

Pay via Cash or Check

Pay Online

Payment Methods