Retreat Registration Form

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Parent Name REQUIRED Please fill out this field. Please enter valid data.
Child's Name REQUIRED Please fill out this field. Please enter valid data.
Parent Email REQUIRED Please fill out this field. Please enter valid data.
Parent Phone REQUIRED Please fill out this field. Please enter valid data.
Please select the option below that applies. REQUIRED Please fill out this field.
Food Allerfies/Medical Conditions REQUIRED Please fill out this field. Please enter valid data.
Volunteers are needed in the following areas. Please check the areas in which you would be interested in helping. REQUIRED Set-Up (night before retreat) Group Chaperone/Escort Practice and Reception of Communion Games Bread Making Bread Braiding Kitchen Volunteer (keep bread stations filled with ingredients) Bible Study Donate Bread Ingredients Tear-down (11:15 AM - 12:15 PM on the day of the retreat) I will work where the need is greatest. I cannot help in any area. Please fill out this field.
If needed, please add any special notes regarding your volunteer preference (1st, 2nd, 3rd choice etc.).
Would you be interested in leading/organizing a session with provided material? If so, check the session/sessions below. REQUIRED Games Bible Study Kitchen I prefer not to lead/organize a session. Please fill out this field.
If needed, please include additional comments or information regarding your interest in leading a session.
I grant permission for my child to participate in the St. Vincent de Paul First Communion Retreat on March 26, 2022 from 7:45 AM to Noon in the St. Vincent de Paul School.

I will not hold the St. Vincent de Paul Parish, or St. Vincent de Paul Parish staff, volunteers, or chaperones associated with this gathering responsible in the event of injury. Further, I agree to accept any and all financial responsibility as a result of scheduling necessary emergency medical treatment.

I will not hold St. Vincent de Paul (Parish / School) responsible for any injury incurred on the trip to and from this gathering. I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.

In the event of emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to treatment by the hospital or doctor.

I Agree Please select this field.
Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
In case of emergence and I cannot be reached please contact (please list name and phone number): REQUIRED Please fill out this field. Please enter valid data.
Family Doctor's Name and Phone REQUIRED Please fill out this field. Please enter valid data.
Family Health Plan Carrier REQUIRED Please fill out this field. Please enter valid data.
Policy Number REQUIRED Please fill out this field. Please enter valid data.
Photo Release
St. Vincent de Paul Parish and the Diocese of Fort Wayne – South Bend are hereby granted permission to publish photographs taken of my child during their attendance at the First Communion Retreat. Photographs may be used in the parish bulletin, parish or school web site, school newsletter, or parish newsletter.

By agreeing to this form, I grant permission for use of photographs and verify that I am the legal parent or guardian of the child named above. I understand that St. Vincent de Paul Parish will not use photographs of my child unless specifically authorized in accordance with the policies of the Diocese of Fort Wayne – South Bend.

I Agree Please select this field.

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