Confirmation Retreat Registration

- Education

January 19 or February 1
Current students preparing for Confirmation in March must attend one of the Confirmation Retreats.
Retreat begins at 8:30am and ends after the 4:30pm Mass
- This is a required event for Confirmation
- Choose prefered date below
- Oline form must be submitted with the $25 registration fee. You can pay by credit card or e-check
- Registration deadline is December 20th
Registration Form
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- Student Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Birth Date (mm/dd/yyyy) REQUIRED
  Please type birth date in mm/dd/yyyy format
  Please fill out this field. Please enter a date.
- Parent Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Retreat Information
- The retreat begins at 8:30am and ends after the 4:30pm Mass. Please select your preferred date REQUIRED January 18, 2020 February 1, 2020 Please fill out this field.
- Please select t-shirt size. They are ADULT sizes REQUIRED Please fill out this field.
- For this retreat, I am in need of 8-10 adults who are willing to Chaperone/help with various aspects of this event. It is important to have adult help to make this event worthwhile and meaningful for the students. Thanks in advance for your wiliingness to help out. If you are interested in helping please fill out the information below.
- Count me in as a Chaperone (need 4-5)
  Complete information below if you are willing to be a chaperone.
  Yes!
- Chaperone First Name Please enter valid data.
- Chaperone Last Name Please enter valid data.
- Chaperone Email Please enter an email address.
- Chaperone t-shirt size. They are ADULT sizes
- Count me in to help with lunch on Saturday (Need 4-5) Yes!
- Lunch Help First Name Please enter valid data.
- Lunch Help Last Name Please enter valid data.
- Lunch Help Email Please enter an email address.
- Statement of Consent and Liability Waiver
- By typing my name below I acknowledge that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I aree on behalf of myself, my child named herin, or our heirs, successors, and assigns, to hold harmless and defend St. Elizabeth Ann Seton Parish, its officers, directors, employees and agents, and the Diocese of Fort Wayne-South Bend, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Fort Wayne-South Bend, its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought againt them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Retreat Fee25.0
Total:

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