Junior & Senior Retreat

Name*

First Last

Phone*

Email*

Gender*

Are you in a bible study?*

Yes
No

Class Year?*

2021
2022

Would you like to participate in-person or virtually?*

In person
Virtual

($15 cost for in-person, $10 for virtual. Free swag goes to both types of participants who attend entire retreat.)

I will be over 18 by the date of retreat*

Yes
No

Other (FOCUS, Staff, etc.)

(For in-person): Do you have any allergies or dietary restrictions?

Where do you live?*

How did you find out about Junior/Senior Retreat?

Check all that apply

E-mail/List serv
Mass announcement
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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Junior & Senior Retreat

10/16/2020 - 10/17/2020

Firm Foundation Retreat Registration

10/16/2020 - 10/17/2020

Firm Foundation Retreat Registration

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