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Retreat Waitlist
Please fill out this form and contact MJ at mj@catholicterps.org when you have done so.
First Name
*
Last Name
*
Phone
*
Email Address
*
Sex
*
Female
Male
Date of Birth
*
Will you be 18 at the time of retreat?
*
Yes
No
Class Year
*
2025
2026
2027
2028
2029
Grad Student
What school do you go to?
*
UMD
Howard
St. Mary’s
American
Other
Are you in OCIA?
*
Yes
No
Do you have any allergies?
*
How did you hear about retreat?
*
E-mail/List serv
Mass announcement
Mass flyer
Personal Invite/Friend
Other
Are you interested in joining a Bible Study?
*
Yes
No
I am already in one!
Emergency Contact Name
*
Emergency Contact Phone Number
*
In the event that I am incapacitated, the following medical information should be considered
Medical Consent
*
In the event of a medical emergency, I consent to having Catholic Terps staff seek out medical services on my behalf in addition to contacting my emergency contact.
Photo Consent
*
I acknowledge that photographs or video recordings of myself at the Catholic Student Center 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 at connect@catholicterps.org.
Submit
Please do not fill in this field.
