2026 Diocesan Altar Server Retreat

Welcome!

Thank you for registering for the 2026 Diocesan Altar Server Retreat! This retreat is an opportunity for altar servers to deepen their relationship with Jesus Christ while growing in their understanding of the sacred ministry they provide at Mass.

EVENT INFORMATION

Date: Saturday, October 17, 2026

Time:
Registration: 9:15 a.m. - 9:45 a.m.
Retreat: 10 a.m. - 3 p.m.

Location:
St. Tobias Parish
1135 Hewitt Street
Brockway, PA 15824

Who May Attend:
Current altar servers in grades 6-12 from parishes throughout the Diocese of Erie.

Cost: FREE and lunch will be provided.

PARTICIPANT INFORMATION

Student name

First NameLast Name

Date of Birth

Date

Age

Grade

Home parish

Parish city

School

School City

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

First NameLast Name

Relationship to student

Cell phone

Please enter a valid phone number.Format: (000) 000-0000.

Alternate phone

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMERGENCY CONTACT

(If different from parent/guardian)

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

MEDICAL INFORMATION

Does your child have any allergies?

If yes, please explain.

Is your child currently taking medications?

Medication(s), dosage and frequency

May your child receive Acetaminophen (Tylenol) if medically appropriate?

May your child receive Ibuprofen if medically appropriate?

May your child receive Aspirin if medically appropriate?

Please list any medical conditions or concerns we should know about. Examples: asthma, diabetes, seizures, food allergies, bee sting allergies, walking assistance.

Is your child currently under a physician's or counselor's care?

If yes, please explain.

Family Physician

Health Insurance Company

Policy Number

LUNCH INFORMATION: Lunch is provided. Please list any food allergies or dietary restrictions.

PARENT PERMISSION, MEDICAL AUTHORIZATION & LIABILITY RELEASE

PLEASE READ CAREFULLY

I, the undersigned parent/legal guardian, give permission for my child to participate in the 2026 Diocese of Erie Diocesan Altar Server Retreat on Saturday, October 17, 2026, at St. Tobias Parish, Brockway, Pennsylvania.

It is understood that reasonable caution will be taken by the organizers to prevent injuries to all participants.

In the event of injury or illness to my child during participation in this event, and if I cannot be reached, I hereby give permission to the designated retreat director, supervising adults and medical personnel to secure any necessary emergency medical treatment for my child.

I, for myself and for my child, our respective heirs and legal representatives, hereby indemnify and hold harmless the Diocese of Erie, St. Tobias Parish, retreat leadership, volunteers, supervising adults and their respective agents, successors, legal representatives and employees from any and all claims, demands and causes of action of whatever kind and nature for actions taken pursuant to this authority.

I agree that in the event of injury to my child, I will apply my hospitalization and/or accident insurance toward payment of the expenses incurred.

I further release and save harmless the Diocese of Erie, St. Tobias Parish, their agents, successors, legal representatives and employees from any and all liability for damages or personal injuries arising from my child's participation in the 2026 Diocese of Erie Diocesan Altar Server Retreat, except for damages and/or personal injuries caused by or arising out of the intentional or willful misconduct of the Diocese of Erie, St. Tobias Parish, their agents, servants or employees.

I have read and agree to the Parent Permission, Medical Authorization and Liability Release. (Required)

CODE OF BEHAVIOR

Participation in the Diocese of Erie Diocesan Altar Server Retreat is a privilege and not a right.

Each participant is expected to attend all scheduled retreat activities.

The behavior of all participants must reflect Christian values at all times.

Participants are expected to:

Treat others with kindness and respect.
Follow the directions of clergy, retreat leaders, staff and volunteers.
Respect church, school and retreat property.
Participate fully in retreat activities.
Refrain from possessing or using drugs, alcohol, tobacco products or vaping devices.

The sponsoring adult from each parish is responsible for the youth from his or her parish throughout the retreat.

Each parish, through its sponsoring adult, accepts responsibility for any damage caused by members of its group.

Retreat staff reserve the right to dismiss any participant whose behavior is disruptive or inconsistent with Christian conduct. Transportation home will be the responsibility of the participant's parent or guardian.

I have read and agree to uphold the Code of Behavior. (Required)

PHOTO, VIDEO & MEDIA AUTHORIZATION

I authorize the Diocese of Erie and its representatives to photograph, videotape and/or interview my child during the 2026 Diocese of Erie Diocesan Altar Server Retreat.

I understand these photographs, video recordings and interviews may be used in diocesan publications, websites, social media, videos and other promotional or educational materials as deemed appropriate.

I understand that if I revoke this authorization in writing, future use of my child's image or interview will cease, and website references will be removed within thirty (30) days of written notification. I understand that printed or published materials produced prior to my revocation may continue to be used.

Media permission

Parent/Guardian Certification

• All information I have provided is true, complete and accurate.
• I have read and understand this registration form and all permissions, authorizations, releases, waivers and policies contained herein.
• I am the parent or legal guardian of the participant, or otherwise have legal authority to complete this registration.
• I give permission for my child to participate in the 2026 Diocese of Erie Word Made Flesh Altar Server Retreat.
• I agree to the Medical Authorization, Liability Release, Photo/Media Release, Code of Behavior and all other terms contained in this registration.
• I consent to entering into this agreement electronically and understand that checking this box constitutes my electronic signature and has the same legal effect as my handwritten signature.

I have read and agree to the Parent/Guardian Certification. (Required)

Youth Agreement

• I have read and understand the Code of Behavior.
• I understand that participating in the 2026 Diocese of Erie Word Made Flesh Altar Server Retreat is a privilege.
• I agree to follow all retreat rules, respect retreat leaders and participants, and conduct myself in a Christ-like manner throughout the retreat.
• I understand that failure to follow the Code of Behavior may result in my parent or guardian being contacted and may result in my dismissal from the retreat.
• I understand that checking this box constitutes my electronic acknowledgment of this agreement.

I have read and agree to the Youth Agreement. (Required)