Student Hope Retreat Registration Form

Student Hope Retreat Registration Form

Please fill out your details to register for Hope Retreat October 15-18, 2026! You will receive instructions for payment by email after completing this form. The cost of this retreat is $50 per student and $25 for each additional student per family.
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
Gender
T-Shirt Size:
Student Email Address
example@example.com
Student Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
We hope to implement a leadership opportunity for returning students. Has your student been on Hope Retreat in the past?
Do we have permission to contact the student about leadership opportunities and past retreat experiences?
What is the student's home parish?
For every 8 teens per parish group, we ask that a safe-environment trained adult chaperone comes. Are you interested in being a chaperone should we need one, or do you know someone that would be interested?
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the student have any allergies or medical conditions?
Please list any dietary restrictions.
Parental/Guardian Consent:

It should be understood that there is always the potential for injury and/or illness inherent in retreat activities. By giving your consent, you are agreeing to taking this risk as well as giving us permission to include your child in all media as pertains to the retreat, including photo and video. You are also giving your consent to the behavior agreement and agreeing that your child will adhere to appropriate clothing and behavior practices: I authorize my child to participate in Hope Retreat, give medical consent, and agree to all conditions as pertain to the multimedia and behavior agreements.
I herby undestand and consent to the statement above.
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. In the event of an emergency, if you are unable to reach me at the above numbers, contact:
Emergency Contact: First Name   Last Name     Relationship

Emergency Contacts Number:  Phone Number

Family Doctor :  First Name   Last Name      Phone Number

Family Health Plan Carrier:   Type a label

Policy #:   Type a label

*Please list any special medical conditions, allergies or medication that would help your child in an emergency:     Type a label
I am the parent or legal guardian of the child named above. I give permission for my child to participate in the retreat and related activities. I understand that reasonable safety measures will be taken to protect my child, and I consent to the supervision and care of my child by the retreat staff and volunteers during the event..
Signature
Date:
Please make a payment following this link:

https://giving.myamplify.io/App/Form/ac9d7c22-35a3-4203-ac66-4a1b21bae8fa
Should be Empty:

Student Hope Retreat Registration Form

Parental/Guardian Consent:

EMERGENCY MEDICAL TREATMENT: