Fall 2018 Antioch CM Registration Form
The COST: $10.00
All payments need to be paid by check or cash.
Times I will DEFINITELY be at the retreat!
I can be the second person in transporting to the host homes.
Cell Phone Number
I have completed the online Diocesan Protocol Training, "Safe and Sacred"
Date of Completion and Parish where you are registered
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.
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Terms of Service