I would like to attend:
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Saturday, June 1st (for 6th-8th grade girls)
Saturday, June 8th (for 9th-11th grade girls)
I would like to be placed on the waiting list for:
May 21, 2022, for 9th-11th grade girls
First Name
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Last Name
*
Parents' Names
*
Phone Number
*
E-mail Address
*
Street Address
*
City / State
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Zip Code
*
T-shirt size (adult sizes):
Sm
Med
Lg
This is my first time to attend:
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yes
no
Age
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School
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Parish
*
How you learned about this event (please be specific):
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Medical History:
*
Allergies:
Current Medications:
Additional Comments:
Emergency Contact Information:
Name
*
First Name
Last Name
Relationship
*
Home Phone
*
-
Area Code
Phone Number
Cell Phone
*
-
Area Code
Phone Number
Liability Release
I give permission to my above named daughter to attend this Carmelite Retreat.
As parent or legal guardian, I remain fully responsible and liable for any claims brought against Carmelite Sisters, DCJ which may result from any action taken by my child.
Electronic Signature (parent's name):
*
Emergency Medical Treatment
In the event of an emergency, I hereby give permission to the Carmelite Sisters, DCJ to transport my child to a hospital to receive emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
I relieve the Carmelite Sisters, DCJ of all responsibility and consequences that may arise as a result of this treatment. I will not hold the Carmelite Sisters, DCJ liable in the event of injury. Further, I agree to accept any and all financial responsibility as a result of medical treatment.
Electronic Signature (parent's name):
*
An $8.00 donation is requested, if possible. This may be submitted on the day of the event or mailed in advance to: Vocation Directress/Carmelite Sisters of the Divine Heart of Jesus/10341 Manchester Road/St. Louis, MO 63122. Checks made payable to Carmelite Sisters D.C.J.
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I understand
If I realize at any point before the event that I can no longer attend, I will cancel my registration as soon as possible.
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I agree
Submit
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