Healing the Whole Person Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Have you been to one of these before? Yes No

Which parish are you coming from? St. Joseph (South Lyon) Holy Family (Novi) St. James (Novi) St. William (Walled Lake) Other

Name of parish if other than one listed above?

Dietary Restrictions None Dairy Free Gluten Free Nut Free Other

Please list other dietary restrictions here: