Retreat Waitlist

Catholic Student Center

Saints Row Brewery

15 Fulks Corner, Gaithersburg, MD 20877

Please fill out this form and contact Matt Aujero at matt@catholicterps.org when you have done so.

If you have not done so, please pay or apply for a scholarship for retreat here.

Name*
First Last
Phone*
Email*
Gender*
Day of birth? (MM/DD/YYYY)*
Are you interested in joining a bible study?*
- Yes
- No
- I'm already in a Catholic Terp Bible Study
Class Year?*
- 2022 (Winter)
- 2023
- 2024
- 2025
- 2026
- Graduate Student
I will be over 18 by the date of 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:
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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Admin