2018 Spring Pharos Retreat Registration
The Spring Pharos Retreat will take place April 6-8th at The Spiritual Center at Maria Stein. This St. Mary Pharos retreat is a great opportunity to take time to reflect upon your relationship with God and to grow deeper in your faith while building strong friendships with your peers. All students are welcome to sign up to attend.

You may pay via Venmo (@stmoxchurch), a check made out to St. Mary's Church, or cash turned into the parish office by March 28th at 4:00pm.

Payment will take place after Spring Break. Please note your registration form is not complete without payment.

Registration cost is $50 - payment will take place AFTER Spring Break. Students will be able to pay electronically or with cash or check. Checks can be made out to St. Mary Church. Scholarships and financial aid are available - contact Pam if interested (pburk@stmox.org).

*******EARLY BIRD SPECIAL: March 5-12. Students who register between March 5-12 will receive an additional $5 off their registration cost!!!*******

Registration will close March 28th so register ASAP!

Last Name *
Your answer
First Name *
Your answer
Phone Number: *
Your answer
Miami Email Address: *
Your answer
Year in School *
Your answer
Do you have a car on campus and are willing to drive yourself and others to the retreat? *
If you are able to drive, how many others can you take in your car?
Your answer
Do you have any allergies or food restrictions? If yes, please explain. *
Your answer
Do you have any medical conditions? If yes, please explain. *
Your answer
Financial Requirements and Scholarship Information
The retreat cost is $50. In the event that you withdraw your registration for the retreat all payments can be refunded, unless you withdraw within one week of the retreat. If you do withdraw within a week of the retreat you are expected to pay for the retreat in full. If paying for this retreat is a challenge please contact us at pburk@stmox.org to discuss financial aid possibilities.
Please check "I Agree" to indicate you have read and understand the above financial requirements: *
Archdiocese of Cincinnati Adult Permission, Medical Release and Power of Attorney
1. I, the undersigned will participate in the activity described on this registration form and release from all liability and indemnify the Archbishop of Cincinnati (the Archbishop), both individually and as trustee for the Archdiocese of Cincinnati and all parishes and schools within the Archdiocese (the ?Archdiocese?), and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost and expenses, including attorneys? fees, arising out of any injury or illness incurred by me while participating in or traveling to or from the activity and further agree not to bring or prosecute or allow to be brought or prosecuted (including but not limited to prosecution through subrogation) in my name, any claims, lawsuits or actions against the Archbishop, the Archdiocese, and their officers, agents, representatives, volunteers and employees.

2. I further understand that my participation is purely voluntary and is a privilege and not a right. I elect to participate in spite of the risks.

3. I agree to cooperate with the Archbishop or his agents in charge of the activity.

4. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel:

5. To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for my best interest.

6. This power of attorney shall lapse automatically upon completion of the activity and related travel.

7. I agree that the Archbishop or his agents may use my portrait or photograph for promotional purposes, website and office functions.

8. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio, except for the choice of law provisions thereof.
I have carefully read and understand and accept the terms and conditions stated herein and acknowledge that this Permission, Release and Medical Power of Attorney shall be effective and binding upon me and my own personal representative or estate, assigns, heirs, and next of kin and that I have signed this agreement of my own free will.

Please check "I Agree" to indicate you have read and understand the above permission form: *
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