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Retreats

- Ministry

Confirmation Retreat May 13th-15th 2022
Location: Pyramid Life Center Pyramid Lake
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- Student Attendee
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
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- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- School REQUIRED Please fill out this field. Please enter valid data.
- Parish REQUIRED Please fill out this field. Please enter valid data.
- Alergies REQUIRED Please fill out this field. Please enter valid data.
- Diet Restrictions REQUIRED Please fill out this field.
- Any Physical Limitations REQUIRED Please fill out this field. Please enter valid data.
- Special Medical Conditions REQUIRED Please fill out this field.
- Insurance Provider REQUIRED Please fill out this field. Please enter valid data.
- Policy # REQUIRED Please fill out this field. Please enter valid data.
- Primary Policy Holder REQUIRED Please fill out this field. Please enter valid data.
- Parents/Guardians/Emergency Contact
- Father
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  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Mother
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. 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.
- Father
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother
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- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Please read and understand the following. When complete hit the SUBMIT button. By hitting the SUBMIT button you agree, understand and will comply to the following:
  
  I grant permission for my child to participate in the above named event. I am aware that cell phone coverage is not always available and sometimes not available at all. I am fully aware that my child will require transportation to and from this event. I understand that said transportation will be my responsibility and if I would like to car pool with other participants it is my responsibility to arrange. I further understand no High School age participant is permitted to drive themselves or others to and from said event.
  I understand that there is inherent risk attending these types of events and that while all safety protocols will be strictly enforced there will remain risk of injury or illness.
  I grant permission, if needed, for my child to be evaluated, diagnosed, treated, and /or medicated in accordance with standard medical practice by licensed medical personnel. I release Pyramid Life Center, Albany Catholic Youth Association INC, Sacred Heart Church Troy, the Roman Catholic Diocese of Albany, it's employees, agents, chaperones, directors, officers or volunteers of all responsibility and consequences that may arise as the result of this treatment.
  I will not hold Pyramid Life Center, Albany Catholic Youth Association INC, Sacred Heart Church Troy, the Roman Catholic Diocese of Albany, it's employees, agents, chaperones, directors, officers or volunteers responsible in the event of injury, illness or death. Further, I agree to accept any and all financial responsibility as a result of scheduling such treatment.
  My child agrees to abide by all rules and regulations decided upon by the Pyramid Life Center, Albany Catholic Youth Association INC, Sacred Heart Church Troy, the Roman Catholic Diocese of Albany, it's employees, agents, chaperones, directors, officers or volunteers. I understand that neither Pyramid Life Center, Albany Catholic Youth Association INC, Sacred Heart Church Troy, the Roman Catholic Diocese of Albany, it's employees, agents, chaperones, directors, officers or volunteers will be held liable if my child fails to cooperate with said regulations and that any infractions of the rules may result in immediate dismissal from the event. I further understand that I will be responsible for any costs or other requirements for immediate transportation home. The participant will not be left unattended while waiting for transportation home.
  Media/Photo Waiver: I hereby authorize and give my full consent to Pyramid Life Center, Albany Catholic Youth Association INC, Sacred Heart Church Troy, the Roman Catholic Diocese of Albany, it's employees, agents, chaperones, directors, officers or volunteers to copyright and/or publish any and all photographs, videotapes and/or film in which my child or myself appear while participating in any programs or events sponsored or chaperoned by Sacred Heart Church Troy. I further agree that they may transfer, use or cause to be used, these photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes and television programs without limitations or reservations.
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