Holy Week Connect Retreat
Cost: FREE

When: Thursday, April 18th arrive at Cathedral of the Incarnation at 6:30 PM (for check-in before Mass at 7 PM) - Friday, April 19th at 1:00 PM

Where: Drop off and Pick up at Cathedral of the Incarnation: 2015 West End Avenue, Nashville, TN 37203

Important Details:
Participants are responsible for travel to and from the Cathedral for the retreat. Please bring an air mattress, blanket, and pillow for overnight lodging. Also, comfortable shoes are suggested for walking as we visit 7 Catholic Churches in downtown Nashville as part of the retreat.

Dinner on Thursday and a light breakfast and lunch will be provided for on Friday of the retreat.

Participant First Name *
Your answer
Participant Last Name *
Your answer
Participant Gender *
Participant Cell Phone Number *
Your answer
Participant E-mail Address *
Your answer
Medical Information
Please list any pertinent medical information here including but not limited to prescription medication and dosages your child will be bringing, allergies, medical conditions, etc...
Your answer
Guardian First Name *
Your answer
Guardian Last Name *
Your answer
Guardian Contact Number *
Your answer
Guardian E-mail Address *
Your answer
Comments
Anything else we need to know...
Your answer
Liability Waiver
As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Philip’s Catholic Church, its officers, directors, employees and agents, and the Diocese of Nashville, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Nashville, its employees and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.

I also give permission for my child to participate in this retreat that includes transportation to a location away from the parish retreat site. This activity will take place under the guidance and direction of parish employees and/or volunteers from Holy Family Catholic Church and St. Philip Catholic Church.

Photo Release
I hereby authorize St. Philip Catholic Church and its agents to utilize my child’s photographic image for the specific purpose of publication of promotional material and official social media accounts. I understand that I will receive no compensation should any photograph of my child be used.
Medical Release
I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, band-aids, antibiotic ointment, hot/cold packs, etc...) to be given to my child, if deemed appropriate.

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

Electronic Signature *
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or regarding this agreement, constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and PARISH/SCHOOL and the Roman Catholic of Diocese of Nashville. You also represent that you are authorized to enter into this Agreement for all persons on whose behalf you are signing this Agreement and that such persons will be bound by the terms of this Agreement.
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of St Philip Catholic Church. Report Abuse - Terms of Service