2017 Kick-off retreat

September 8-10 /// Damascus Catholic Mission Campus

 

 

arrival time: 6:00pm friday
Return Time: 11:00am Mass at st. catharine

Cost: $115 (payable to St. Catharine) As always, never let cost keep you from this or any retreat, just register and God will take care of the money!

Deadline to Register: September 7th

Please complete the form below

I. Registration
Name *
Name
Participant Cell Phone *
Participant Cell Phone
II. Permission
The undersigned hereby state(s) that (he/she/they) (is/are) the (parent/parents/guardian) of the above named Participant and have full legal responsibility for the Participant. The undersigned hereby grant(s) permission for the Participant to participate in the Activity named in Section I.B., above.
III. RELEASE AND INDEMNIFICATION
A. Release. The undersigned on behalf of the undersigned, the Participant, and the heirs, successors and assigns of the undersigned and the Participant, hereby release, hold harmless from any liability, and discharge from all direct or derivative claims, actions, causes of actions, medical expenses, costs, legal expenses, other expenses and all other damages at law or in equity, known or unknown, direct or indirect, choate or inchoate against the Diocese of Columbus, the Parish and all current and former employees, agents, clergy, officers and volunteers of the Diocese of the Parish, arising from the Participant’s participation in the Activity named in Section I.B., above. B. Indemnification. The undersigned shall indemnify and hold harmless the Diocese of Columbus, the Parish, and all current and former employees, agents, clergy, officers and volunteers of the Diocese of Columbus or the Parish from any claim, liability, suit, judgment, loss, damage, expense, fee or cost (including court costs and attorney fees) arising directly or indirectly from the Participant’s participation in the Activity named in Section I.B., above, unless arising from the negligence of an indemnified party.
IV. SPECIFIC MEDICAL INFORMATION AND MEDICATION
A. Specific Medical Information. The Parish will take reasonable care to see that the following information will be held in confidence.
The Participant is taking medication at present. The Participant will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for taking such medications, including dosage and frequency of dosage, are as follows:
Please check one of the following
V. EMERGENCY MEDICAL CONTACT AND TREATMENt
Parent or Guardian *
Parent or Guardian
Phone *
Phone
Phone
Phone
B. Emergency Medical Treatment
In the event of an emergency, the undersigned hereby give(s) permission to transport the Participant to a hospital for emergency medical or surgical treatment. The undersigned wish(es) to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if the undersigned cannot be reached at the above numbers, contact: *
In the event of an emergency, the undersigned hereby give(s) permission to transport the Participant to a hospital for emergency medical or surgical treatment. The undersigned wish(es) to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if the undersigned cannot be reached at the above numbers, contact:
VI. CONSENT FOR RELEASE OF PERSONALLY IDENTIFIABLE INFORMATION
The undersigned hereby consent to the release of photographs and name of the Participant to be used by the Diocese of Columbus and St. Catharine of Siena for future promotional programs of the Diocese and Parish. If you have any questions or concerns, please contact Brendan O'Rourke at 614-231-4509
VII. CODE OF BEHAVIOR
The Participant shall comply with the following:
1. The Participant must stay and participate in the entire event. The Participant may not leave the premises unless accompanied by an adult leader, parent, or legal guardian. 2. The possession or use of alcohol, tobacco, drugs, or weapons of any kind is not permitted. 3. Foul language is not tolerated. 4. The Participant must comply with any and all directions of activity staff. 5. The Participant must respect the rights and property of others. Damage to or defacing of property will be the financial responsibility of the Participant involved and the undersigned. 6. Failure to abide by this Code of Behavior may result in a request to the undersigned to transport the offending Participant from the premises, and the undersigned shall immediately comply with the request.
VIII. Signatures
Participant's Digital Signature *
Participant's Digital Signature
Date *
Date
Parent or Legal Guardian's Digital Signature *
Parent or Legal Guardian's Digital Signature
Date *
Date
I agree to allow all of the above contained information in Section I, Section IV, and Section V to be used for all future Saint Catharine Youth events for the 2017-2018 academic year. *
Information may be amended. This does not give permission for future events, but simply allows personal, medical, and emergency contact information to be held on file and carried over for the sake of convenience.

If you are paying by cash or check, simply hit submit and you are finished!

If you want to pay online via St. Catharine's secure online giving site, hit submit and follow the directions given.