Disabilities Retreat Registration Form

God Put a Song in My Mouth (2019)

"God Put a Song In My Mouth"

Spring Retreat for persons with Disabilities

Saturday, April 27  |  Doors open at 9 AM  |  2 PM Dismissal 
St. Vincent's Msgr John Kuzmich Life Center

Lunch will be provided
Wear Comfortable Clothing
If medication is needed, please be sure to bring dosage instructions

Name
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E-mail
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Address
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Phone --
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Date of Birth //
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Parish which you attend
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I need assistance in the following areas:
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(If transfer is needed, please enter weight)
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Other needs:
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Specific Instructions (special assistance)
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I use:
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Special Dietary Needs (gluten, diabetic, etc)
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I will need an American Sign Language Interpreter
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Signature
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Guardian's Signature (if required)
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Photo Release
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By selecting YES, I do hereby stipulate that I am the person or guardian of the person listed herein and expressly consent and agree that St. Vincent de Paul Parish may include images of person registering in photographs or video recordings, which may appear in the parish bulletin, newsletter or on the parish website.
 
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