Box City – Mary Our Queen

Join us for prayer, fellowship, and hard work as we brave through the night together. This is an immersive experience for our youth to grow in understanding of poverty and to deepen their sense of charity .

Box City Permission Form

Register here for our Box City on October 18-19 at Mary Our Queen. Participants must currently be in 6th - 12th grade in the 2024-2025 school year to register. Registration is not complete until payment has been submitted.

Name of Participant(Required)

First Last

Date of Birth(Required)

Grade(Required)

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

School(Required)

Parent Name(Required)

First Last

Parent Email(Required)

Parent Mobile Number(Required)

Allergies or Health Concerns(Required)

Current Medication (and dosage)(Required)

Emergency Contact Person(Required)

First Last

Emergency Contact Phone(Required)

Relationship to Participant(Required)

Insurance Carrier(Required)

Policy Number(Required)

Copy of Insurance Card

Max. file size: 200 MB.

Parent/Guardian Signature(Required)

In signing this form, I certify that all information contained herein is true and accurate to the best of my knowledge.