Heartland TEC Candidate Registration
If you would like to be a retreat candidate at the next Heartland TEC retreat, please fill out the information below completely. All information is needed for the retreat to be a wonderful experience! The cost for the retreat is $95 per candidate. Please bring your money to the retreat. Make checks out to "Heartland TEC."
Name of Candidate:
Your answer
Gender:
Date of Birth
MM
/
DD
/
YYYY
Address:
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Name of High School/College:
Your answer
Grade/Year:
Your answer
Parish/Church:
Your answer
Is the candidate a practicing Catholic?
Parents Information:
Father's Name:
Your answer
Mother's Name:
Your answer
Parents' Address:
Your answer
Parents' Phone Number:
Your answer
Parents' Email
Your answer
Has either parent been to a TEC weekend
Required
Medical Information
Allergies
Please describe any allergies to medications or foods
Your answer
Medical problems or special circumstances (e.g. diet) we should be aware of
Your answer
Medical Release Form
I give permission for my child to be treated by a doctor in case of emergency on the TEC weekend. I further release TEC from liability for any physical injury that they might incur in conjuncton with TEC weekend. The director of said gathering may act as my agent in my absence. I also grant permission for any pictures of myself or my child to be used for advertising purposes. Checking Yes = Personal Signature
Required
Emergency Contact Name:
Your answer
Emergency Contact Phone Number:
Your answer
Personal Information of Applicant
How many siblings do you have?
Your answer
Do you play a musical instrument? If so what do you play?
You can bring the instrument along on the weekend.
Your answer
Describe any special interestes or hobbies.
Your answer
Describe your participation in school activities.
Your answer
Describe your participation in your parish/church.
Your answer
Describe any other retreat experiences.
Your answer
Please share some reasons for attending this TEC retreat weekend at this time.
Honesty is the best policy for this answer.
Your answer
What are your ambitions or plans for the future.
Your answer
What is your T-shirt size?
Your answer
Release of Information
I give TEC permission to include my name, address, phone #, e-mail address and date of birth in the weekend roster to be printed for the weekend along with any pictures to be used to advertise for future TEC retreats. Checking yes signifies that you agree.
Required
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