Ignite Retreat Permission Form

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This form is to register for the Ignite retreat at St John Vianney's Hall 23 Police Road Mulgrave on the 12th April. Please fill out the information below so that the retreat organizers have the details for the event. We will email a pdf of your form for you to sign and then email back to us. Bring the $25 in cash on the day (Sorry no eftpos). For more information go to http://mayostudios.org You can contact us Robert Zaar – 0449172083.

Email: mayostudios1@gmail.com

What is the child's first name? *

What is the child's last name? *

What school does the child go to? *

What year level is the child in? *

What is the parent's first name? *

What is the parent's last name? *

Parent's email? *

Please confirm parent's email. *

What is the child's address? *

What is the parent's phone number? *

What is the child's age (as of 10th Dec 2022) *

Are there any Special Needs (dietary)? *

Are there any medical conditions we should know about? *

Medicare number? *

In the case of an emergency I give permission for the staff on the retreat to arrange any medical assistance on my behalf. *

Yes

Who is the emergency contact? (First and last name) *

What is the emergency contact's phone number? *

Would you like to receive future invites about retreats?

Yes

Clear selection

Is your child coming for the whole retreat or only part? If only part what is the arrival or departure time?

Submit

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