Adult Retreat Registration

  1. Adult Retreat
  2. Payment
  3. Review
Release Liability
By placing my name at the end of this form, I am agreeing to attend the Adult Retreat at St. Mary-of-the-Woods College, St. Mary-of-the-Wood, Indiana. The retreat will leave from Guerin Catholic High School on a Coach bus Monday, October 2nd, 2017. Please arrive to Guerin Catholic by 6:30 AM. The bus will return to Guerin Catholic by 4:30 PM.
I hereby consent and agree to hold harmless St. Theodore Guerin Catholic High School and/or the Roman Catholic Diocese of Lafayette-in-Indiana, Inc., and any and all employees or volunteers thereof, for any accident, injury or occurrence arising out of, or in connection with the activity and my event arranged transportation necessary to participate in the aforementioned activity. I understand I will ride the Coach bus, provided by Miller Transportation to and from St. Mary-of-the-Woods.
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Medical Information
Emergency Medical Treatment: In the case of an emergency, I hereby give my permission to the school, it's officers, directors, faculty, staff, volunteers, agents, and the Diocese of Lafayette-in-Indiana, agents, representatives, volunteers and employees of either the diocese of any parish/school thereof, and chaperones or representatives associated with this event to transport my student to a hospital for emergency medical or surgical treatment. I further authorize any medical, dental and/or necessary and proper medical treatment for the care of my student. I understand that I will be notified as soon as possible in the event that an emergency arises requiring medical assistance occurs.
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Please provide an emergency contact for the day:
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