2019 Orthodox Christian Youth Retreat Registration Form
The Orthodox Christian Youth Ministry Team has been hosting annual youth retreats for over 10 years. The team members (Tina Soubeih, Mary Wright, Olivia Ingram and Leeanna Castor from St Paul, Brier, WA and Joy Ann Wise from St. Thomas) are overseen by a spiritual advisor Fr. Michael Gillis from Holy Nativity in Langley BC. The team goal is to keep our youth connected to the Church by providing an enriching Orthodox weekend experience. The retreats provide the youth from Orthodox Churches in WA state (and bordering states within a 6 hour driving radius of retreat locale) and their friends an opportunity to grow in their faith, interact with Orthodox priests, strengthen their connection to the Church, form and renew lasting Orthodox friendship bonds, and have fun in a Christian Orthodox setting.

For more detailed information about the retreat and the information you will need, please view the information packet at http://stpaul-orthodox.org/Registration.pdf. You can download that packet and fill it out if you like, but this online form is preferred. If you're ready to go, let's get started!

Youth First Name *
Your answer
Youth Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Grade *
Your answer
Gender *
Parish *
Your answer
Home Address *
Your answer
Home City, State, Zip *
Your answer
Youth Email
(include if you give permission to share with other retreat participants)
Your answer
Phone (Youth Mobile)
Your answer
Parent(s)'/Guardian(s)' Name(s) *
Your answer
Parent/Guardian Email *
Your answer
Phone (Home)
Your answer
Phone (Parent/Guardian Mobile) *
Your answer
Cabin Request
Is there a friend or friends you'd like to share a cabin with?
Your answer
What is your child looking forward to at the retreat?
Your answer
Are there special fears, worries or concerns your teen may have about the retreat?
All information is regarded as STRICTLY CONFIDENTIAL and will only be shared with appropriate staff.
Your answer
Are there circumstances in our teen's life that would be helpful for us to be aware of? (ie death of relative/divorce/family trauma)
All information is regarded as STRICTLY CONFIDENTIAL and will only be shared with appropriate staff.
Your answer
My teenager is under the legal custodial care of:
Your answer
Please provide any additional information about the participant's behavior, physical, emotional, dietary restrictions, or mental health of which our team should be aware.
Your answer
List of approved individuals allowed to pick up my teenager from the retreat.
If this changes please indicate at the check-in registration or call Camp Director at 425-835-3317.
Your answer
Please indicate your response to the Permissions and Agreement Form by choosing an option below. This agreement is legally binding. This information collected is for use of the Orthodox Christian Youth Ministry Team for the retreat. Information is not shared.
If you answered "Yes, with conditions" above, please list the activities that your child cannot participate in below, along with the reason for the exemption.
Your answer
We want to have as few rules as possible at the retreat, but some rules are absolutely necessary and need to be understood by all participants and their parents/guardians. Agreeing to this contract is required of all participants and at least one of your parents or guardians. Please read the form very carefully. These rules will be STRICTLY enforced. BOTH YOUTH AND GUARDIAN MUST READ AND THEN CHECK THE BOX.
Required
Photo Release *
I grant Orthodox Christian Youth Ministry Team the absolute right to copyright, re-use, publish and republish by any medium, including electronically, any photos of my child or in which they may be included, that may be taken while participating in the retreat.
Required
Camp Waiver Form: Have you printed, signed, and prepared to mail the camp waiver form along with the medical information and insurance card and payment? Form can be found at: https://drive.google.com/file/d/1aNFYC-WzJz96LOpS4gBQ3BEpBs5dr89Q/view *
Required
Medical Info Form: Have you printed, filled out and prepared to mail the medical information form along with insurance card, camp waiver, and payment? Form can be found at: https://drive.google.com/file/d/1R31z2MhOZ_v6gGMejuIXCakKkyuB40mC/view *
Required
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