Team Application
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Do you belong to any social networks? *
What Parish or Church do you belong to? *
Your answer
What high school do you attend? *
Your answer
What grade will you be in at the time of the retreat? *
How old will you be at the time of the retreat? *
Your answer
Have you attended Virtus Training? *
If you answered No, would you be interested in Virtus Training?
In what Journey role do you see yourself? *
Check as many that apply
Required
Would you be interested in giving a talk? *
Why do you want to be on Team? *
Your answer
What did you learn on your Journey? *
Your answer
What did you learn on your Journey, about Yourself? *
Your answer
What did you learn on your Journey, about God? *
Your answer
On Journey we present a lifestyle of prayer, study and action as ways to grow in your faith. Have you incorporated or deepened your activity in any or all of these areas? *
As part of the Journey team we ask that you make Journey a priority and plan personal, school and work activities around our formation meeting schedule. Can you commit to this? *
If No, please explain why
Your answer
Medical Information
Do you have any allergies? *
If Yes, please list them:
Your answer
Are you taking any required medications? *
If Yes, please list them:
Your answer
Do you have any special medical considerations? *
If Yes, please list them:
Your answer
Do you have any special dietary considerations or restrictions? *
If Yes, please list them:
Your answer
What is the date of your last Tetnus booster? *
MM
/
DD
/
YYYY
What is your the name of your Medical Insurance Company? *
Your answer
What is the Policy/Group Number? *
Your answer
What is the name of the Primary Person on the policy? *
Your answer
Emergency Contact Information
Emergency Contact Name *
Your answer
Emergency Contact Home Phone Number? *
Your answer
Emergency Contact Cell Phone Number? *
Your answer
Primary Backup Emergency Contact Name? *
Your answer
Primary Backup Emergency Contact Phone Number? *
Your answer
Secondary Backup Emergency Contact Name?
Your answer
Secondary Backup Emergency Contact Phone Number?
Your answer
Please send your payment of $200.00 to:
ST. KATERI TEKAKWITHA PARISH ATTN: Journey Retreat Program
2216 Rosa Road, Schenectady, NY 12309
Please make check payable to the Journey Retreat Program
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