DIOCESE OF CORPUS CHRISTI DIOCESAN CONFIRMATION RETREATS

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1 DIOCESE OF CORPUS CHRISTI 620 Lipan St. Corpus Christi, Texas Pastoral Parish Services Office of Youth Ministry (361) Fax (361) DIOCESAN CONFIRMATION RETREATS Our Lady of Victory - Beeville, TX (Beeville Deanery) February 21, 2015 Nuestra Senora de San Juan de Los Lagos, Madre de la Iglesia - Corpus Christi, TX (Spanish) February 21, 2015 Our Lady of Good Counsel- Kingsville, TX February 28, 2015 Pax Christi Liturgical Retreat Center - Corpus Christi, TX March 7, 2015 St. Paul the Apostle Corpus Christi, TX March 21, 2015 Every year, the Diocesan Youth Ministry Office sponsors Diocesan Confirmation Retreats for those parishes that are unable to conduct their own retreat or for those candidates that missed their parish confirmation retreat. Therefore, we will be sponsoring 5 separate day retreats, four in English and one in Spanish, which candidates and their sponsors may choose from. The group registration form must be completed by the Pastor, Director of Religious Education, or Youth Minister of the parish. The total cost of the day retreat is $50 for both candidate and sponsor together. This is to cover the retreat expenses including a hot lunch. The deadlines for the February 21 st retreats are Friday, February 13 th. The deadline for the February 28 th retreat is Friday, February 20 th. The deadline for the March 7 th retreat is Friday, February 27 th. The deadline for the March 21 st retreat is Friday, March 13 th. Space is limited so seats are confirmed with the first paid group registration forms until seats are full. Late registrations will not be accepted. Attached consent and liability forms will also be required to participate in the Diocesan Confirmation Retreat. There is an Adult Participation form to be completed by the sponsor. Sponsors are required to attend the retreat with their candidate. If a sponsor can t attend, a proxy must attend (such as one of the parents or guardians). There are forms in Spanish available online at for the retreat taking place at Nuestra Senora de San Juan de Los Lagos, Madre de la Iglesia on February 21, For more information, you may Heath Garcia at

2 February 21, 2015 Our Lady of Victory Church 707 North Avenue E, Beeville, TX Parish Hall Open to Confirmation s & their Sponsors Registration Deadline for February 21 st Retreat: Friday, February 13, 2015, 5:00pm Sponsors are required to attend the retreat with the Confirmation

3 February 21, 2015 Nuestra Senora de San Juan de Los Lagos, Madre de la Iglesia 1755 Frio Street, Corpus Christi, TX Parish Hall Open to Confirmation s & their Sponsors Registration Deadline for February 21 st Retreat: Friday, February 13, 2015, 5:00pm Sponsors are required to attend the retreat with the Confirmation

4 February 28, 2015 Our Lady of Good Counsel Church 1102 East Kleberg, Kingsville, TX Community Building Open to Confirmation s & their Sponsors Registration Deadline for February 28 th Retreat: Friday, February 20, 2015, 5:00pm Sponsors are required to attend the retreat with the Confirmation

5 March 7, 2015 Pax Christi Liturgical Retreat Center 4601 Calallen Drive, Corpus Christi, Texas St. Joseph Hall Open to Confirmation s & their Sponsors Registration Deadline for March 7 th Retreat: Friday, February 27, 2015, 5:00pm Sponsors are required to attend the retreat with the Confirmation

6 March 21, 2014 St. Paul the Apostle Church 2233 Waldron Road, Corpus Christi, TX Parish Hall Open to Confirmation s & their Sponsors Registration Deadline for March 21 st Retreat: Friday, March 13, 2015, 5:00pm Sponsors are required to attend the retreat with the Confirmation

7 Diocese of Corpus Christi/ Office of Youth Ministry Parish: Diocesan Confirmation Retreat PARENTAL/GUARDIAN CONSENT, LIABILITY WAIVER AND MEDICAL CONSENT Page 1 of 2 (Youth Consent) Participant s Name Home Address City Parent(s)/Guardian(s) Home Phone ( ) Alternate Phone Number: ( ) Parish or Catholic School Date of Birth Zip Code Cell Phone Grade Age Sex PARTICIPATION CONSENT, LIABILITY WAIVER & PHOTOGRAPHY/VIDEOGRAPHY CONSENT Important! To be filled out by the Parent/Guardian for youth under 18 years of age. If participant is 18 years of age or older, consent must be signed by the individual) I (name of parent/guardian), grant permission for my child, (participant s name), to participate in the Diocesan Confirmation Retreat to be held at February 21, 2015 at Our Lady of Victory in Beeville, TX, February 21, 2015 at Nuestra Senora de San Juan de Los Lagos, Madre de la Iglesia in Corpus Christi, TX, February 28, 2015 at Our Lady of Good Counsel in Kingsville, TX, March 7, 2015 at Pax Christi Liturgical Retreat Center in Corpus Christi, TX and March 21, 2015 at St. Paul the Apostle, Corpus Christi, TX.. I agree on behalf of myself, my child s other parent if known or living (name of parent), my child named herein, or our heirs, successors, and assigns, to release and hold harmless and defend the Diocese of Corpus Christi, the sponsoring parish (its pastor, youth minister, principal, other agents, etc.) or any representatives associated with the scheduled activity from all damages, claims, suits, expenses and payments for injury to my child and/or property, including all damages, claims, suits, expenses and payments resulting from the negligence of the Diocese of Corpus Christi, and parish, and/or their officers, directors, and employees. As parent/guardian, I understand that promotional pictures (individual and group) will be taken during this event. I give permission for my son s/daughter s picture to be used for promotional materials (newsletter, web page, calendars, power point, video, etc.) in highlighting the event. Signature (Parent/Guardian) Date Signature (Participant 18 years of age or older must sign own consent) Date

8 MEDICAL CONSENT Medical Matters I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Of the following statements pertaining to medical matters, sign only those in accordance with your wishes: 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 and you are unable to reach me, contact: Name & Relationship Family Doctor Phone Phone Medications: My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows: Medication(s): Dosage: Administer: I hereby Do Not Grant Permission for medication of any type, whether prescription or nonprescription may be administered by my child unless the situation is life threatening and emergency treatment is required. (Please initial) I hereby Grant Permission for nonprescription medication (such as Tylenol, throat lozenges, cough syrup) to be given to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter. (Please initial) Medical Conditions Information (Diocesan personnel will take reasonable care to see that the following information will be held in confidence.) Allergic reactions to the following (foods, dyes, latex etc.) Has had a medical surgery within the last six months? Yes No Still under doctor s care? Yes No Has a medically prescribed diet? The following physical limitations? Immunizations current and up to date: Yes No Date of last tetanus/diphtheria immunization You should also be aware of these special medical conditions of my child: Insurance Information (Please attach a copy of the Insurance Card, front and back, with this form) Insurance Carrier: Name of Insured: Insurance Policy Number: Page 2 of 2 (Youth Consent) Father s Name: Mother s Name: Day Phone: Day Phone: No, I do not carry medical insurance at this time. In the event it comes to the attention of the chaperones associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately. If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly. Signature (Parent/Guardian) Signature (Participant 18 years of age or older must sign own consent) Date Date

9 Diocese of Corpus Christi and/or Parish of Adult Participant s (Sponsor) Release of Liability and Medical Release Form Name: Parish: Daytime Phone # Address: City: State: Zip: Health Insurance Carrier: Insurance ID Number: Insurance Policy Number: Name of Event: Diocesan Confirmation Retreat Date(s) of Event: February 21 & 28, March 7, or March 21, 2015 Location of Event: Our Lady of Victory, Beeville, TX, Nuestra Senora de San Juan de Los Lagos, Madre de la Iglesia, Corpus Christi, TX, Our Lady of Good Counsel, Kingsville, TX, Pax Christi Liturgical Retreat Center, Corpus Christi, TX, or St. Paul the Apostle, Corpus Christi, TX I agree on behalf of myself, my heirs, successors, executors, personal representatives and assign to protect, indemnify, save, and hold harmless the Diocese of Corpus Christi, and parish, and their officers, directors, agents employee, or representatives associated with this event/trip from all damages, claims, suits, expenses and payment on account of or resulting from conditions stated on or resulting from any such injury, death, or damage to property, including resulting from the negligence of the Diocese of Corpus Christi, and parish, and/or their officers, directors, and employees arising from or in connection with my attending youth ministry events. In the event that any legal action is taken by either party against the other party to enforce any of the terms and conditions of this agreement, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all court costs, reasonable attorneys fees and expenses incurred by the prevailing party. In the event that I should require medical treatment and am not able to communicate my desires to attending physicians or other medical personnel, I give permission for the necessary emergency treatment to be administered. Please advise the doctors that I have the following allergies: In case of an emergency and for permission for treatment beyond emergency procedures, please contact: Emergency Contact Name: Relationship to me: Day Time Phone #: Night Time Phone #: (Signature) (Date)

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