Fall 2024 “Stir Into Flame” Retreat

Name*

First Last

Phone*

Email*

Sex*

Day of birth? (MM/DD/YYYY)*

Are you interested in joining a bible study?*

Yes
No
I'm already in a Bible Study

Class Year?*

Will you be 18 by retreat?*

Yes
No

Do you have any allergies or dietary restrictions?*

How did you find out about this retreat?

Check all that apply

E-mail/List serv
Mass announcement
Mass flyer
Personal Invite/Friend
Other (Let us know below)

Other:

Emergency Contact Name*

Emergency Contact Phone Number*

In the event that I am incapacitated, the following medical information should be considered

Allergies, Meditations etc.

I am authorizing that, in the event I am incapacitated, and the emergency contact cannot be reached, I give permission for medical services to be administered.**

Check to authorize

I assume responsibility for my own actions and safety on the retreat and therefore release the Catholic Student Center and Archdiocese of Washington DC of any liability which may arise from my participation in this retreat.*

Check to authorize

These liabilities include travel by bus or car, sleeping in cabins, potential outdoor activities, meals, etc.

I acknowledge that photographs or videotape of participants may be used in publications, websites or other materials produced by the Catholic Student Center. If you do not wish to be photographed or filmed, you must notify us in writing.*

Check to authorize

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Fall 2024 “Stir Into Flame” Retreat

10/04/2024 - 10/06/2024

Fall 2024 “Stir Into Flame”

Fall 2024 "Stir Into Flame" Retreat

10/04/2024 - 10/06/2024

Fall 2024 “Stir Into Flame”

Fall 2024 "Stir Into Flame" Retreat

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