Confirmation Retreat

I am a parent/guardian registering my child(ren) REQUIRED Yes Please fill out this field.

I am registering: REQUIRED 25.0 – One child 50.0 – Two children Please fill out this field.

Name of Attendee 1:

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

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

Gender REQUIRED Male Female Please fill out this field.

Grade REQUIRED Please fill out this field. Please enter valid data.

Name of Attendee 2 (if applicable):

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Grade Please enter valid data.

Home Parish REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Please bill my parish Yes

Parent Name:

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

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

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

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

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

Please list any medical conditions, allergies, or dietary needs which would affect participation in this event.

I, the parent/guardian, give permission for my child(ren) to participate in the Spiritus Confirmation retreat: REQUIRED Yes Please fill out this field.

I release and hold harmless Spiritus Ministries, Immaculate Conception parish, and any persons connected with the retreat from liability, claims, or damages for personal injury, property loss, or other damages which may result during the retreat. REQUIRED Yes Please fill out this field.

I consent to the use of likeness in any manner relating to communication production in any media. REQUIRED Yes No Please fill out this field.

My child agrees to abide by the rules established for the Spiritus Confirmation retreat. REQUIRED Yes Please fill out this field.

I authorize the treatment for my child(ren) in the event of a medical situation occurring during my absence or when the hospital or physician(s) are unable to contact me. REQUIRED Yes Please fill out this field.

I release medical responsibility and liability to the hospital, physician(s) and nursing personnel for performing medical procedures acting on the authority of this medical consent form which such medical providers deem necessary for my child(ren). REQUIRED Yes Please fill out this field.

If you are paying for your child(ren)'s participation, select 'Pay Now.' If the parish will be paying, select 'Pay Later.'

Confirmation Retreat

Saturday, January 11th, 2025

Register by January 1st: