Fall 2018 Antioch CM Registration Form
Oct 5th-7th

The COST: $10.00

All payments need to be paid by check or cash.

Your answer
Your answer
T-Shirt Size
Your answer
Times I will DEFINITELY be at the retreat!
Your answer
I can be the second person in transporting to the host homes.
Your answer
Cell Phone Number
Your answer
Email address
Your answer
Emergency Contact
Your answer
Food Allergies
Your answer
I have completed the online Diocesan Protocol Training, "Safe and Sacred"
Date of Completion and Parish where you are registered
Your answer
I hereby consent and agree to hold harmless Saint Lawrence Catholic Church and/or the Roman Catholic Diocese of Lafayette-in-Indiana, Inc., and any and all employees or volunteers thereof, for any accident, injury or occurrence arising out of, or in connection with the aforementioned activity.
I have read the above and waiver and agree to the terms within.
I give my permission, in case of an emergency, to be taken to a physician or hospital by an adult retreat member. I hereby give permission to the physician selected by the adult retreat member to secure proper treatment for myself.
I have read the above statement and agree to the terms within.
Never submit passwords through Google Forms.
This form was created inside of St. Lawrence Catholic Church. Report Abuse - Terms of Service