Junior Retreats 2025-26

Junior Fellowship Retreat Permission 2025-26

All Junior Retreats will take place at Our Lady of Fatima Retreat House, Indianapolis

Student's First Name*

Student's Last Name*

Retreat Date*

November 5-7, 2025November 19-21, 2025February 11-13, 2026April 8-10, 2026

For more information about the retreat, please Click here.

Parent/Guardian #1*

Relationship to student*

Parent/Guardian Contact Email*

Emergency Phone #1 *

Emergency Contact #2*

Emergency Phone #2 *

INSURANCE INFORMATION (Both lines MUST be completed.)

Family Health Insurance Company*

Policy Number*

Allergies, Reactions, Medical or Dietary Limitations

Please enter any allergies, medical conditions, dietary restrictions and other items that we should be aware of:

Will your student be bringing prescription or over the counter medicines to the retreat?*

YesNo

Name and strength of medicine(s)*

Please be as specific as possible for each medicine

Prescribing Doctor*

Enter NA for any over the counter medicines

Dosage and Directions*

Please indicate the medicine and be as specific as possible

Purpose of the medicine(s)*

Any additional notes

Parents/Guardians:

I hereby request that an authorized representative of Bishop Chatard High School make available the above described prescription to my son/daughter/youth listed above during the retreat, in accordance with the information I have entered above.

Parent Responsibility for use of Inhaler

I confirm that my child/youth has been made aware by me that his/her inhaler is for his/her use only and may not be shared with others.

My child/youth has been made aware by me that he/she must notify a staff member immediately following each use of an inhaler in case follow-up response is needed.

------------

Bishop Chatard High School is not responsible for ensuring that the above medication(s) is taken and is relieved of responsibility for the benefits or consequences of the child/youth using or not using the medication as described above.

By typing in my name below, I indicate that I have read this information and consent to the information.

Parent/Guardian Signature for medicines*

First NameLast Name

Participation Consent & Relinquishing of Claims against BCHS

Read the BCHS Parent/Guardian Permission Policy

By typing in your name below, you, the parent/guardian, are indicating you've read the permissions policy & officially grant permission for your student's participation and medical release.

Parent Guardian Signature*

First NameLast Name

Current Date*

If you have any concerns, please contact Brian Farrell, bfarrell@bishopchatard.org

Reply to - Admin