Gwynedd Mercy (Host) with La Salle College High School & Mount St. Joseph Academy
Wednesday, March 10, 2010
Registration: 6:00–6:30 pm
Event:6:40–9:15 pm

1345 Sumneytown Pike
Gwynedd Valley, PA  19437

You are invited to join the students and faculty of Gwynedd Mercy with La Salle College High School & Mount St. Joseph Academy to discuss important issues in society that can affect youth, educators, and parents. You will be participating in one breakout session on the topics listed below. We ask students and parents to fill out the registration forms below and submit by Monday, March 8th. Only one person can be registered on this form but the form may be filled out as many times as needed.

Click here for details on breakout session topics.

• Title: Ms. Mrs. Mr.        • You are a : Youth Educator Parent / Guardian

• First Name:

• Last Name:

• Gender : Male Female            • Grade:(if a student)

• Phone:    • School Association:


• Address:


• City:     • State:   • Zip:


• Email:

• To assist us in identifying family members when assigning you to your preferred workshop please list the names of other family members attending:
(Separate Registrations are needed for each individual listed below).

Please note, family members will not be placed in the same breakout rooms.



• Rank your choices in order of preference:

First choice:
Stress & Perfection
Modern Technology
Sex and Pressure
Drugs and Alcohol
Parent-Child Relationship and Communication

 Second choice:
Stress & Perfection
Modern Technology
Sex and Pressure
Drugs and Alcohol
Parent-Child Relationship and Communication		 Third choice:
Stress & Perfection
Modern Technology
Sex and Pressure
Drugs and Alcohol
Parent-Child Relationship and Communication



If you do not give us your permission to use your image in video or photography, please check here.





Please note that all participants will be attending 1 breakout session. Youth and parents from the same family will not be placed in the same breakout session.

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