Crew Retreat May 26-27, 2019
This is the sign up form for the Crew Retreat. This retreat is for all who are interested in being on theIntersection Crew for our 2019-2020 school year for St. Nicholas and St. William Catholic Parish. It is open to all those currently in 7th grade to 11th grade.

This will be a time for the teens to learn more about Crew, hear how we work as a team, understand how we build and grow our faith to share with others and the responsibilities of being on Crew. This is a required retreat for Crew.

This retreat will start with the 5 pm mass at St. William on Sunday, May 26. We will then meet in the Sr. E Teen Center at St. William and sleep in this room, the office upstairs and/or the hall as needed based on numbers. The retreat will end on Monday at 5 pm.

Please have your teen bring a sleeping bag, a pillow, toiletries and if they like a blow up mattress or sleeping cushion as we we will be "camping" inside. The cost of this retreat for three meals is $33 per person and can be paid online (PayPal button will be added to our website at https://stnicholasandstwilliam.org/theintersection-teen-program/) or by check prior to the retreat.

Please fill out the form below for each teen in your family who is interested in being on Crew and will be joining us for the retreat May 26 to May 27, 5 pm to 5 pm at St. William Church.

Rules:
1) No drugs, alcohol or weapons of any kind will be permitted. If a teen comes or uses any of these during the retreat, parents will be notified, they will be sent home and not allowed to participate on Crew for the year.
2) Respect for all persons and the St. William property is required.
3) This is a team building event, all should be open to sharing and participating.
4) Be open to having an amazing 24 hours and be filled with the Holy Spirit!

Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Gender *
School for 2018 - 2019 school year *
Your answer
School for 2019-2020 school year *
Your answer
Grade for 2019-2020 school year *
Home Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Participant's Cell Phone *
Your answer
Participant's Email *
Your answer
Parent 1 Cell Phone *
Your answer
Parent 1 Email *
Your answer
Parent 2 Cell Phone *
Your answer
Parent 2 Email *
Your answer
Home Phone Number *
Your answer
Second Home Phone Number if Two Homes
Your answer
Special Dietary Information *
Your answer
Food Allergies or Medical Conditions *
Your answer
Participant's Doctor's Name *
Your answer
Participant's Doctor's Phone Number *
Your answer
Participant's Dentist's Name *
Your answer
Participant's Dentist's Phone Number *
Your answer
Medical Insurance Company *
Your answer
Medical Insurance Policy Number *
Your answer
Name of Emergency Contact other than Parent *
Your answer
Phone Number of Emergency Contact other than Parent *
Your answer
Relations of Emergency Contact other than Parent *
Your answer
Is there any information you feel as a parent we should know about your teen? *
Your answer
Photo Release: By checking the opt-in box below, I hereby grant permission for my child to be photographed and/or videotaped during this event. I understand that my child may decline to be photographed and/or videotaped at any time. I further grant permission for the resulting photograph and/or videotaped footage to be edited, if necessary, and then published and/or broadcast for the purpose of promoting the Faith Formation and Sacramental Prep Programs. *
Release: I request that the Roman Catholic Diocese of San Jose, St. Nicholas & St. William Parish, permit my child to participate in the Faith Formation, Sacramental Prep Programs and /or Youth Retreats to be held at St. William Catholic Church through September 2019. I understand that reasonable precautions will be taken to safeguard the health and well-being of my child, and that I will be notified as soon as possible in the event of an emergency. In case of sickness or accident, I authorize and consent to any x-ray exam, anesthetic, medical, dental or treatment and hospital care to be rendered to my child under the general care and advice of any physician, dentist or surgeon licensed to practice in any state. I further understand and agree to be responsible for any such medical, dental and/or hospital expenses incurred. *
Name of Electronic Signature for release above *
Your answer
We have read the rules, agree with them and discussed them with our teen. *
Name of Electronic Signature for rules above *
Your answer
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