ECHO Stillwater | Teen Registration Form

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PARTICIPANT'S NAME* This field is required.If you are a parent filling this out for your child, please be sure you are putting in your child's info below.
First Name
Last Name
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SEX* This field is required.
Male
Female
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DATE OF BIRTH* This field is required.
Month
Day
Year
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AGE AT THE TIME OF RETREAT* This field is required.To qualify for this retreat, teens must be juniors, seniors, or recent graduates as of Fall 2023.
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GRADE LEVEL* This field is required.Please select the grade you are going into Fall 2023. If you graduated high school in Spring 2023, select 'Recent Graduate.'
Junior
Senior
Recent Graduate
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CONTACT INFORMATIONIf you are a parent filling this out for your child, please be sure you are putting in your child's info below.
Participant's Email Address
Home Phone Number
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MAILING ADDRESS* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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DIOCESE & PARISH INFO
Name of Diocese
Name of Church Parish
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T-SHIRT SIZE* This field is required.
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
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PARENT/GUARDIAN INFOPlease include contact information below for at least one parent or guardian.
Name of Parent/Guardian #1 (First, Last)
Parent/Guardian #1 Phone Number
Parent/Guardian #1 Email Address
Name of Parent/Guardian #2 (First, Last)
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email Address
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INSURANCE & PHYSICIAN INFO* This field is required.In the event of an emergency, we want to be able to get you/your child the medical services you need. Please carefully fill out the information below.
Name of Participant's Health Insurance Provider
Policy Number
Name of Primary Care Physician
Phone Number of Primary Care Physician
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EMERGENCY CONTACT PERSON* This field is required.In case of an emergency, who should we contact?
Name of Emergency Contact Person
Phone Number of Emergency Contact Person
Relationship to Participant
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MEDICAL & ENVIRONMENTAL ALLERGIESPlease list below any medicines the participant is allergic to, as well as any environmental allergies we should be aware of.
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DIETARY RESTRICTIONSWe do our best to provide great food options for those with dietary restrictions. However, our cooks are not always able to accommodate every situation. If this situation arises, we will contact the participant regarding dining options.
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NOTE REGARDING PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS:

We have a medical professional or delegate as part of the ECHO staff. Upon arrival, please give any prescription medication to the medical delegate located at the registration area with specific dosage instructions for your child. We ask that medications be delivered in this manner to keep your child and other children safe. These medications will be returned to the parent/guardian at the end of the retreat.

We keep basic over-the-counter medications in stock at ECHO, including Advil, Tylenol, Benedryl, Zyrtec, Allegra, Claritin, Pepto-Bismol, cold and flu medications, and all first-aid supplies. Participants will be instructed to see the medical delegate if any of these are needed during camp.

A detailed log of all medication given will be kept by the medical delegate for the safety of all participants.
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PRESCRIPTION & OTC MEDICATIONSPlease list below any prescription or over-the-counter mediations your child will bring with them to ECHO.
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MEDICAL LIABILITY WAIVER* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS AND CONDITIONS FOR THEMSELVES. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE ON THEIR BEHALF. I hereby authorize Echo Community to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness for myself/or my child. This authorization inclusively extends from June 5-8, 2023. I hereby warrant, to the best of my knowledge, I/my child are in good health, and I assume all responsibility for myself/my child. In the event of an emergency, I hereby give permission to transport myself/my child to a hospital for emergency medical or surgical treatment. I ask you to advise the person(s) listed as the emergency contact to any further treatment by the hospital or doctor. I assume full financial responsibility for any medical treatment expenses I may incur. I agree to either pay for services upfront, or if Echo Community pays, I agree to be billed and reimburse their expense.
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PAST ECHO EXPERIENCE
Yes
No
Is this your first ECHO?
If you answered "no" above, please list any past ECHO experiences you've attended.
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BRIEFLY EXPLAIN WHY YOU WANT TO ATTEND* This field is required.ECHO is an immersive experience into the depths of our identity as men and women through the lens of St. John Paul II's Theology of the Body. We explore themes of sexuality, vocation, prayer, and relationships. We want to make sure you want to dive in!
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HOW WOULD YOU DESCRIBE YOUR KNOWLEDGE OF THE THEOLOGY OF THE BODY (NO WRONG ANSWER):
"I can quote it"
"I get the gist"
"I've heard of it"
"What's that?"
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WHAT ARE YOUR TRAVEL PLANS FOR ECHO AT STILLWATER?* This field is required.We are able to offer shuttles to and from Lafayette Regional Airport (LFT). Please let us know how you will be traveling to ECHO below, and we will be in contact with you regarding shuttle options if needed.
I will be driving
I will be flying
I am not sure yet
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HOUSINGStillwater Catholic Retreat Center offers bunk-style housing for teens. If you have friends you prefer to bunk with, please list their names below. We cannot guarantee we can give you your selection, but we will do our best.
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A QUICK NOTE ABOUT YOUNG ADULTS SERVING AT ECHO:

At ECHO, you/your child will have a group of awesome young adults to journey alongside you during your experience. They've spent the previous weekend receiving the retreat themselves and will be eager to share with the teens what they've received.

MENTOR TEAM
The mentor team will journey alongside teens by leading our version of small groups, called "family groups." They will work together as they help teens unpack and process what they are receiving during sessions and throughout their experience of the retreat.

PRAYER TEAM
The prayer team is the backbone of the retreat. They will spend time meeting together while praying and interceding for the teens throughout their experience of ECHO.

HOSPITALITY TEAM
The hospitality team's main task is to create and maintain spaces during ECHO to help teens encounter Christ and have an amazing ECHO experience.

Per standard diocesan regulations, all young adults who are attending ECHO and serving teens provide proof that they are Safe Environment trained, have cleared a background check, and are in good standing with the Catholic Church.
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GENERAL LIABILITY WAIVER* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS FOR HIMSELF/HERSELF. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE TO THESE TERMS ON THEIR BEHALF. As parent and/or legal guardian, or myself if 18 years or older, I remain legally responsible for any personal actions taken by myself or 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 Echo Community, the Diocese of Lafayette, Family Missions Company, Stillwater Catholic Retreat Center, their officers, directors, agents and staff, chaperones, or representatives associated with the event, arising from or in connection with myself/my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Echo Community, the Diocese of Lafayette, Family Missions Company, Stillwater Catholic Retreat Center, their officers, directors, staff, agents, chaperones, or representatives associated with the activity for reasonable attorney' fees and expenses arising in connection therewith.
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ILLNESS POLICY WAIVER* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS FOR HIMSELF/HERSELF. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE TO THESE TERMS ON THEIR BEHALF. In an effort to minimize the spread of infectious illnesses, we ask that if you are experiencing signs or symptoms of illness prior to the retreat, please contact our office to discuss your options. If symptoms appear during your time on retreat, we will assess the situation accordingly and you may be asked to quarantine on site or depart in order to minimize the spread of illness on campus. PLEASE NOTE: While we will do our best to minimize the risk of the spread of illnesses such as COVID-19, there is no such thing as no risk. It is up to you to discern your decision to attend. ECHO is a retreat rooted in authentic relationships with God and with the community. We strive to do everything we can to preserve these opportunities for authentic community, while at the same time keeping everyone safe. However, there is never no risk involved. As we say often, love looks forward! We will rely on everyone’s help to love one another well by abiding by the precautions, while at the same time encouraging everyone to take advantage of all the opportunities to grow in friendship and community. By signing this form, you are acknowledging that you understand and agree to hold Echo Community as well as Stillwater Catholic Retreat Center NOT LIABLE for any illness contracted before, during, or after the retreat on June 5-8, 2023.
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PHOTO RELEASE & VIDEO CONSENT* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS FOR HIMSELF/HERSELF. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE TO THESE TERMS ON THEIR BEHALF. In consideration of the taking and use of the photographs or video footage of the named below, for good and valuable consideration herein acknowledged as received, I hereby grant to Echo Community the irrevocable and unrestricted right and permission to take, use, re-use, publish photographic pictures of me/my child or those of which I or they may be included, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or another matter that may be used in connection therewith or the use to which it may be applied. In exchange for the benefits derived by my participation, I hereby agree that I, my child, or any heirs, distributes, guardians, legal representatives, and assigns to do release and will indemnify, hold harmless the photographer or videographer, Echo Community for claims for libel or violation of any right of publicity or privacy or privacy arising out of or in connection with my participation in the photography or videography project, from whatever cause, including the active or passive negligence of the photographer, videographer, or Echo Community.
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ECHO CODE OF CONDUCT* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS FOR HIMSELF/HERSELF. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE TO THESE TERMS ON THEIR BEHALF. VIOLATIONS OF ANY OF THE REGULATIONS LISTED BELOW MAY RESULT IN YOUR IMMEDIATE RETURN HOME AT YOUR EXPENSE: 1. All camp directors, chaperones or counselors are to be respected at all times; instructions are to be followed. 2. Alcoholic beverages, tobacco, illegal drugs, and weapons or dangerous items of any sort are positively forbidden. 3. Room/cabin assignments may not be changed once assigned. 4. Members of the opposite sex may not visit each other’s rooms/cabins at any time. 5. Inappropriate public or private displays of affection are not allowed at any time during the camp. 6. Anyone damaging property will be held responsible for the cost of damages. Echo Community, the Diocese of Lafayette, Family Missions Company, and Stillwater Catholic Retreat Center are not responsible for damage expenses that an individual incurs. Theft of property is forbidden. 7. You must be on-time for all scheduled activities. Failure to follow this rule may result in loss of privileges at this camp. 8. Obscene or abusive language, and inappropriate comments will not be tolerated. 9. Modesty in dress and behavior is required. 10. Participants must act as positive role models at all times during the camp and respect the property and residents of Stillwater Catholic Retreat Center. 11. Participants must participate in all scheduled activities. 12. CAMPERS ARE RESPONSIBLE FOR VALUABLES. Please do not bring valuables such as jewelry, expensive electronics, etc. Echo Community, the Diocese of Lafayette, Family Missions Company, and Stillwater Catholic Retreat Center are not responsible for loss, damage, or theft that may result to such items.
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CANCELLATION POLICY* This field is required.*IF THE PARTICIPANT IS 18 YEARS OR OLDER, PLEASE HAVE HIM/HER READ AND AGREE TO THESE TERMS FOR HIMSELF/HERSELF. *IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT/GUARDIAN MUST AGREE TO THESE TERMS ON THEIR BEHALF. 1. There is a non-refundable deposit of $100 required to secure your spot at ECHO. In the event of cancellation this amount cannot be refunded. 2. If cancellation occurs on or before Monday, May 22, 2023 (10 business days prior to the retreat), you will be refunded any monies paid over $100. 3. If cancellation occurs after Monday, May 22, 2023, we are unable to reimburse any ECHO registration fees and you are still responsible for the full registration balance.
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ECHO REGISTRATION FEES:

ECHO RETREAT COST:
$425 (On or before March 15th)

$475 (After March 15th)

*We require at least a $100 deposit to secure your spot at ECHO.

*Registration cost covers all food, lodging, and retreat supplies. You are only responsible for your transportation to and from camp.

*We do offer customizable payment plans, fundraising tools, and limited scholarships to those in need. Email us at retreats@echocommunity.us to inquire.
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PAYMENT METHODSWe are able to accept online payments via credit and debit cards as well as mail-in checks. A $100 deposit is required to secure your spot at ECHO.
I will pay my $100 deposit via mail-in check, and remaining balance by May 22th.
I will pay my $100 deposit online via debit or credit card, and remaining balance by May 22th.
I will pay in full via mail-in check.
I will pay in full now via debit or credit card.
My church is covering my registration cost.
Please select your preferred payment method
If your church is paying, please add name of the church contact person
If your church is paying, please include the church contact person's phone number
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SIGNATURE OF AGREEMENT* This field is required.By signing below, you agree to all the terms and conditions listed in the above Medical Liability Waiver, General Liability Waiver, Illness Policy Waiver, ECHO Code of Conduct, and the Cancellation Policy. If participant is 18 years of age or older, please have him/her sign below. If participant is under the age of 18, a parent/guardian must sign below on their behalf.
Clear
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HOW DID YOU HEAR ABOUT ECHO?
Youth Minister/Priest Told Me About It
A Friend Told Me About It
Radio Advertisement
Email Advertisement
Social Media Post
Jason Evert/The Chastity Project
Postcard or Flyer
Echo Community Speaker or Event
Other
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CONGRATS, YOU DID IT!

Upon clicking submit, you will be automatically directed to our payment info page, where you can pay online and/or get mailing info to send a check.

Upon receiving your registration form and initial payment, we will send you confirmation of your acceptance via email along with a packing list.

Contact us at (985) 951-2215 or at retreats@echocommunity.us with any questions or concerns. We can't wait to see you at ECHO at Stillwater in June!
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