Confirmation Preparation

Confirmation Preparation 2016-2017 Catholic Faith Communities of St. William & St. John Neumann

Important Dates to Remember June 12, 2016 Initial Interviews (SW) All registration forms, permission slips, personal assessment, and payment due at this time. September 11, 2016 Large Group (SW) Sponsor Form Due October 21-23, 2016 Confirmation Retreat Option 1 November 4-6, 2016 Confirmation Retreat Option 2 December 11, 2016 January 15, 2017 February 5, 2017 February 19, 2017 February 26, 2017 Large Group, Teaching Mass 2 p.m. (SJN) All-City Confirmation Speaker 10:30 a.m. St. Joe s Gym Multicultural Day Option 1, All Saints Multicultural Day Option 2, Great Spirit Candidate/Sponsor Reflection and Fellowship (SJN) March 12 (SW) and 19 (SJN), 2017 Final Interviews Sponsor Recommendation, all service hours, letter to Bishop, and Name essay DUE! CONFIRMATION REHEARSAL AND DATE TBD.

Confirmation Schedule 2016-2017 Date/Time Event Description Location Sunday, May 1, 2016 6:30pm - 8:00pm Confirmation Orientation Candidates and Parents must attend and will receive all materials and information about Confirmation Preparation, and will sign up for an initial interview. St. John Neumann Church Sunday, June 12, 2016 9:00am - 1:00pm Confirmation Initial Interview Candidate and a parent will attend a 15- minute interview. Personal assessment, all completed permission slips, and payment are due. St. William Parish Hall Sunday, September 11, 2016 6:30pm- 8pm Large Group and Small Group Orientation Candidates, Parents, and Sponsor must attend. Please bring personal calendars so small group meeting dates can be arranged. Sponsor information due. St. William Parish Hall September, 2016 Time: October, 2016 Time: October 21-23, 2016 Small Group Use the space provided to fill in details. Small Group Use the space provided to fill in details. Confirmation Retreat Option 1 Confirmation Retreat is mandatory for all candidates. Make sure your schedule is clear. Small groups, including Catechists and Peer Leaders, will attend together. Camp Whitcomb Mason (bus from SW) November 4-6, 2016 Confirmation Retreat Option 2 Confirmation Retreat is mandatory for all candidates. Make sure your schedule is clear. Small groups, including Catechists and Peer Leaders, will attend together. Camp Whitcomb Mason (bus from SW) November, 2016 Time: Sunday, December 11, 2016 2:00pm 3:30pm December, 2016 Time: Small Group Use the space provided to fill in details. Large Group Small Group Use the space provided to fill in details. Teaching Mass. Candidates only, parents and sponsors do not need to attend. This Mass will count as a Sunday Mass, so candidates do not need to attend a weekend Mass prior to this event. St. John Neumann Church

Sunday, January 15 2017 10:30am 12:00pm All-City Large Group Candidates only, parents and sponsors do not need to attend this presentation and dialogue with a selected guest speaker. St. Joseph Gym January, 2017 Time: February, 2017 Time: Sunday, February 5, 2017 Sunday, February 19, 2017 Sunday, February 26, 2017 4pm-6:30pm Small Group Use the space provided to fill in details. Small Group Use the space provided to fill in details. Multicultural Day Option 1: All Saints Multicultural Day Option 2: Great Spirit Candidate/ Sponsor Evening Each small group will choose to attend one of two Multicultural Masses to experience the universality of the Catholic Church. Transportation to and from the event will be provided. Each small group will choose to attend one of two Multicultural Masses to experience the universality of the Catholic Church. Transportation to and from the event will be provided. Candidates attend with their sponsor for a time of reflection, fellowship, and meal sharing. All Saints Catholic Church (bus from SW) Congregation of the Great Spirit (bus from SW) St. John Neumann March, 2017 Time: Sunday, March 12, 2017 9:00am-Noon OR Sunday, March 19, 2017 9:00am Noon April, 2017 Time: Date TBD 6:30 p.m. the week before Confirmation Date TBD Date: Time: Small Group Use the space provided to fill in details. Confirmation Final Interview Small Group Use the space provided to fill in details. Confirmation Rehearsal Candidates will sign up for a private final interview with a member of the Confirmation Team. At this interview you will turn in your letter to the Bishop, Confirmation name essay, and sponsor recommendation. Confirmation rehearsal is mandatory for all Candidates and their Sponsors. If a sponsor is unable to attend, a parent must attend in their place. St. William Vercelli House OR St. John Neumann St. William Confirmation Come, Holy Spirit! St. William

DEAR CANDIDATES, Welcome to preparation for the Sacrament of Confirmation. This is a very important time in your faith journey during which you will be exploring your dedication to being a disciple of Christ and your commitment to practicing that discipleship within the Catholic Church. The Sacrament of Confirmation is one of the Seven Sacraments of the Catholic Church. Like all Sacraments, Confirmation is a public expression of an inward reality, namely, your commitment to God. Most often, you will hear that Confirmation is becoming an adult in the Catholic Church. While that is entirely true, it is an insufficient definition of the grace that you will receive at Confirmation because we tend to think of Confirmation as an end, a graduation from Christian Formation. On the contrary, Confirmation is the beginning of your next step in the never-ending journey of faith, in which you are sent forth, as the apostles were, to share the love of God with all people and to live out your Catholic Faith in a real and tangible way. By choosing to be confirmed you are not saying you have all the answers you are saying yes to being a disciple of Christ and to being an active member of the Catholic Faith. Additionally, you are affirming your desire to know God, to love God, and to serve God, as we are all created to do. Just as the Apostles were strengthened by the Holy Spirit on Pentecost, you too will receive the Gifts of the Holy Spirit to shield and guide you in your mission. In Confirmation, the grace given to you at Baptism is sealed and strengthened. Your parents and Godparents spoke for you at Baptism, but in Confirmation you speak for yourself, and you claim the Catholic Faith as your own. This is your Confirmation and your strengthening of faith. In Confirmation, you will receive the maturity and protection of Christ himself by the power of the Holy Spirit. This choice is yours no one can make it for you. We ask for full and active participation in Confirmation Preparation, but keep in mind that no one can force you to be confirmed. This is your decision, and the Confirmation Preparation program is meant to help you say yes to God with conviction and courage. Finally, please know that your parents, Godparents, families, sponsors, and the faith communities of St. William and St. John Neumann all support you as you prepare for Confirmation. We pledge to be examples in word and deed of the living Gospel of Christ. We encourage you to actively participate in your parish through attendance at Mass, other parish events, and through a commitment to Christian service. Blessings and Peace, Julie Dennert Director of Youth Ministry St. William Parish Joann Nelson Director of Lifelong Faith Formation St. John Neumann Parish

STUDENT RESPONSIBILITIES: Fulfillment of ALL SUNDAY and Holy Day obligations. Participation in ALL small and large group sessions, initial and final interviews, and other events. Participation in Confirmation retreat. A minimum of 30 hours of service in the areas of liturgy, community, group, and parish. When you miss an event, you will complete any assigned make-up work. More than 2 absences can delay receiving the sacrament. Write a letter to the Bishop and a Confirmation Name Essay and complete all discussion topics with sponsor. Choose a sponsor that can truly help you in your Christian growth and complete all Candidate/Sponsor Discussion s. Take this journey of Confirmation with classmates, parents and sponsor. Have an active prayer life. Strive to live as a true disciple of Christ, following Christian morals and values. Receive the sacrament of Reconciliation before the sacrament of Confirmation. Set goals for the future of your faith journey. Requirements of Confirmation SPONSOR RESPONSIBILITIES: Fulfillment of ALL SUNDAY and Holy Day obligations. Pray for your candidate and share your faith with your candidate. Attend September Parent/Sponsor meeting and February Reflection and Fellowship with candidate. Meet with your candidate at least 6 times. Take the journey of Confirmation with your candidate. PARENT RESPONSIBILITIES: (Detach here) Fulfillment of ALL SUNDAY and Holy Day obligations. Pray for your child and share your faith with your child Help your child to make Confirmation a priority. Help your son/daughter remember and schedule all Confirmation activities on their calendar and yours. Attend parent meetings with your child. Help your son/daughter choose Confirmation for themselves and not to please others. Take the journey of Confirmation with your son/daughter. CONFIRMATION PARTICIPATION AGREEMENT I agree to commit myself to fulfilling all of the requirements listed above. I am aware that the fulfillment of these requirements is my responsibility. I understand that I will be expected to participate in all scheduled activities of the program. If I am going to miss a session, I will call my catechist and the Youth Ministry Office. I will complete any make up material given to me by the Youth Ministry Office. In the event of a second missed session, the Youth Minister will call me and set up a meeting to discuss postponement of Confirmation until the next year. I will strive to grow as a person of prayer, faith, service, and sharing. I pray for the grace to prioritize my faith commitment and grow in spiritual maturity, as well as all areas of my life, in a special way during this year of preparation for Confirmation. CANDIDATE SIGNATURE: DATE: PLEDGE OF PARENTAL SUPPORT AND GUIDANCE We pledge support and guidance to our son/daughter as he/she begins the process to confirm the faith we have nurtured since Baptism. We understand this is a journey we will take together with our son/daughter. We promise to encourage our son/daughter in the standards mentioned above. PARENT SIGNATURE: DATE:

Letter to the Bishop Each confirmation candidate is expected to write a request letter to the Bishop who will be presiding at your confirmation. This letter is your chance to claim the Sacrament of Confirmation as your own, and to show that you are ready to receive the gift of God s Grace. **You should know that the Bishop personally reads all of the letters sent to him, so put some time and thought into your letter. All of the letters will also be read by the Youth Minister before they are sent to the Bishop.** Guidelines: Letters should be typed and signed by hand, and should be 1-2 pages in length, (1 page minimum). Plan on dedicating at least one paragraph to as many of the points below as possible. This is a formal letter, address it to the Bishop or Archbishop as follows: Most Reverend 3501 South Lake Drive Milwaukee, WI 53207 The Salutation then can read: Dear (Arch)Bishop The text of your letter should include thoughtful and prayerful responses to the following questions (in any order): 1. Introduce yourself to the Bishop. Be sure to include the following: a. Give your name, parish, and some brief biographical information about yourself. b. State that you are seeking/preparing for the Sacrament of Confirmation. c. State when/where you will be celebrating the Sacrament of Confirmation. 2. How has your relationship with God become more important/grown deeper in your life over the course of the past few years (especially over the past year)? 3. Why are you ready for Confirmation? What have been some of the highlights of your preparation for Confirmation? What have you enjoyed? Where have you struggled? (Think about service activities, classes, retreats, small group, etc.) 4. Describe in specific terms (Mass, daily Bible reading, continued service work, etc.) how you will follow Christ and the Church after being confirmed. 5. Do you have any specific concerns regarding the Church or the world as you head into the future? What struggles do you face as a young Catholic? 6. What goals do you have for the future? What prayer requests do you have? 7. Feel free to add any additional ideas that may surface. Some helpful reminders: Be sure to proof read your letter! Use complete sentences, and complete words (do not use text message abbreviations such as u instead of you.) The word God is always capitalized. Letters should be returned at your March interview, and will be delivered to the Bishop in one group. DO NOT mail your letter individually!

Confirmation Name In Confirmation, the confirmation candidate is asked to provide a name by which they want to be confirmed. Throughout the Church s history, this name is either a name of a Catholic Saint who has characteristics and qualities the candidate would like to exemplify, or it is the candidate s baptismal name. The first is much preferred as it is a chance to express the personal desires and reflection of the candidate. By choosing a Confirmation name, you are choosing who you want to be the kind of person that you want to be. Choosing the name of a saint who has the virtues, characteristics and qualities that you want -a saint who is the type of person you want to be - allows you to claim that identity for yourself, and to have the spiritual support and intercession of that patron saint. By choosing your baptismal name, you reaffirm the unity between Baptism and Confirmation. You will need to write a (maximum) 1-page reflection on your choice of Confirmation name. The reflection paper should state the name you have chosen and why you chose that name. This paper is NOT meant to be a research paper or biography about a specific saint, but rather an explanation of why you are identifying yourself with this name. *Note: If you are choosing your baptismal name, you still need to write a paper. Because I like my name is not a sufficient reason and is nowhere near 1-page long. Put some thought, prayer, and effort in to this! There are thousands of incredibly inspiring saints out there. Below are some guidelines from our Bishops to clarify some of the requirements: Candidates may use their baptismal name or another Christian name when receiving the Sacrament of Confirmation. o A Christian name would be the name of a saint or blessed. Derivatives of names (Kelly for Catherine; Jenna for Genevieve) or Old Testament names are also appropriate. Candidates may use their first or middle names if they are Christian names (i.e. reaffirming baptismal name), or they may select a new Christian name. The candidate should know the relationship of the name to the religious Christian tradition. Exceptions can be made if a particular non-christian or family name has significant meaning for a candidate that can be articulated to the Bishop. Most importantly, candidates should be encouraged to learn about their patron as part of their preparation for the sacrament and should particularly focus on the virtues of their patron they wish to emulate. At your Confirmation, the celebrating Bishop will often ask each of you, individually, what name you chose and why you chose it, and he may ask you additional questions about the person you chose. This paper will help you prepare for that! Papers are due on or before the date of your March Confirmation Interview

When choosing a sponsor, keep in mind the following guidelines. A Sponsor for the Sacrament of Confirmation must: be chosen by the candidate to be confirmed. Sponsor Selection Information be at least 16 years old, and be confirmed. be an active, practicing Catholic who has received the sacraments of Baptism, Confirmation and Eucharist and leads a life in harmony with the faith and the role to be undertaken not be a parent of the Candidate Canon Law does not allow parents to sponsor their own children. (If necessary, a parent may serve as a proxy for a Sponsor at the celebration of the Sacrament but he/she cannot be the sponsor.) Sponsors are called to act as companions, models, witnesses, and spiritual guides. Select a sponsor who will challenge you in your faith, and who you see as having more wisdom about their faith than you do. You will be meeting frequently with your sponsor, so be sure he/she is someone with whom you feel comfortable talking about your faith. When choosing a sponsor, please keep in mind that your sponsor is expected to interact with you on a regular basis, both at church and outside of church and location should be taken into consideration. A sponsor must also be willing to respond to a candidate s questions, and research answers whenever possible. The Youth Ministry Office is available for any aid in this matter. Please prayerfully consider who will support you, guide you, and be a true companion with you on your faith journey, both this year and throughout your whole life. As long as the sponsor meets the requirements listed above, a sponsor can be a family member, Godparent, or friend. Who will pull you back when you fall away, and rejoice in the Lord s blessings with you? Who will be there to support you through all things? If you are having trouble selecting a Confirmation Sponsor, or if you are having trouble finding someone who meets all the requirements, please contact the Youth Ministry Office for help. Once you have asked this person to be your sponsor, and he/she has accepted, please give them the gold sheet to be completed and returned to the Youth Ministry office no later than our large group session on Sunday, September 11, 2016.

DEAR SPONSORS, Thank you for responding to your candidate s request to accompany them on this Confirmation journey. Your support and guidance is truly a blessing! There are four specific times throughout the year that you will be asked to attend meetings with your candidate. They are: - Large Group on September 11, 2016, at 6:30 p.m. in the St. William Parish Hall. This session is for all candidates, sponsors, and parents. - An afternoon of reflection and fellowship on February 26, 2017 at 4 p.m. at St. John Neumann. - Confirmation Rehearsal date to be determined. Be sure to check with your candidate. - Confirmation date to be determined. Be sure to check with your candidate. The date of Confirmation is determined by the Bishops offices sometime in the early fall and will be communicated to candidates and their families as soon as possible. The date for rehearsal will be based on the date assigned to us for Confirmation. In addition to attending these meetings, we ask that you meet with your candidate on a regular basis throughout the year. At the Large Group meeting in September, you will receive a magazine with a set of questions to consider with your candidate. Each topic should be covered, but you may choose to discuss more than one topic at each meeting. Take time to explore the questions together and allow the conversation to take you wherever it leads. Please use the salmon sponsor form to track your conversations with your candidate. This form, which includes a Sponsor Recommendation Letter, must be completed and turned in by the candidate at the Final Confirmation Interview in March. In addition to these candidate and sponsor conversations, you are encouraged to take an active role in your candidate s preparation journey. Some ways that you can show your support for your candidate may be by attending Mass together, doing service projects with your candidate, helping your candidate write his/her letter to the Bishop and helping him/her choose a Confirmation name. Above all else, be sure that you are praying for your candidate during his/her Confirmation journey. Thank you again for accepting this responsibility!

Sponsor Information CONGRATULATIONS! You have been asked to be a sponsor for the Sacrament of Confirmation. In accepting this role, you are urged to reflect on the importance of this commitment. Please read the following and pray about the responsibilities you will be fulfilling in the candidate s spiritual life. Please return this completed document to your candidate before: Sunday, September 11, 2016 Or, please forward to: St. William Youth Ministry 440 N. Moreland Blvd. Waukesha, WI 53188 PLEASE READ THIS CAREFULLY: As a sponsor, I: 1. Have received the Sacraments of Baptism, Confirmation, and Eucharist, and I am sixteen years of age or older. 2. Participate regularly in Sunday Mass. I give witness to my faith in Jesus Christ by regularly receiving the Eucharist. 3. Actively strive to live out my commitment to Christ and to the life of the church in daily life. 4. Actively strive to live out my commitment to Christ by making personal prayer and relationship with Him part of my regular day. 5. Will support the person I am sponsoring by my prayers and by the example of my Catholic faith as practiced in daily life. 6. Will support the faith journey of my candidate throughout his/her year of preparation and thereafter. 7. Will complete the required Candidate/Sponsor discussion sessions, attend all required meetings/rehearsal as I am able, and be present for the Sacrament of Confirmation. SPONSOR: I have been requested to sponsor in the Sacrament of Confirmation. Candidate s first and last name SPONSOR S NAME: Fist Name Middle Initial Last Name SPONSOR S ADDRESS: Street Address City State Zip RELATIONSHIP TO CANDIDATE: (e.g. cousin, aunt, friend) I am a registered and participating member of: Catholic Church in City State I have read the above, I fulfill all the requirements, and I am willing to act as a Sponsor for the Sacrament of Confirmation. Sponsor Signature Date

Candidate and Sponsor Meeting Record Please keep a record of the dates that you and your candidate meet to discuss Confirmation and complete the suggested discussion questions in the Sponsor handbook. CANDIDATE S NAME: MEETING 1: WHAT IS YOUR IMAGE OF JESUS? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation? MEETING 2: WHAT DO YOU BELIEVE? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation? MEETING 3: HOW SHOULD I LIVE? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation? MEETING 4: WHERE DO I BELONG? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation?

MEETING 5: HOW DO I PRAY? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation? MEETING 6: WHAT IS MY DESTINY? Date: What did you talk about? Is there anything noteworthy about the candidate s progress toward Confirmation? LETTER OF RECOMMENDATION Dear Faith Communities of St. William and St. John Neumann, As the sponsor of, I attest to this individual s sincerity and effort in his/her journey toward Confirmation. I believe that through formation, prayer, service, and faith he/she has adequately prepared to receive the Sacrament of Confirmation. I, therefore, personally recommend that this candidate be Confirmed in the Holy Catholic Church. Please add any additional assessments or comments: In Christ, Sponsor Signature Date

REGISTRATION FOR THE SACRAMENT OF CONFIRMATION FEE FOR CONFIRMATION IS $220, ALL-INCLUSIVE CANDIDATE INFORMATION T-SHIRT SIZE S M L XL FULL NAME: HOME PARISH: CANDIDATE S EMAIL CANDIDATE S CELL PHONE BIRTH FATHER S NAME BIRTH MOTHER S MAIDEN NAME ADDRESS (First) (First) (Last) (Maiden) CITY STATE ZIP CANDIDATE LIVES WITH: FATHER MOTHER BOTH OTHER FATHER S PHONE (Home) (Cell) (Email) MOTHER S PHONE (Home) (Cell) (Email) CANDIDATE INFORMATION: FOR OUR PARISH RECORDS DATE OF BIRTH CITY OF BIRTH BAPTISM DATE OF BAPTISM * PARISH OF BAPTISM CHURCH ADDRESS CITY STATE ZIP * If not baptized at St. William or St. John Neumann, please submit a copy of baptismal certificate with this form. MEDICAL CONSENT In the event of an injury or illness, I/we give permission to transport my child to a hospital for emergency medical treatment. I/we also grant permission to any and all health care providers designated by St. William and/or St. John Neumann Staff to provide all children listed above any and all necessary medical care related to the injury or illness. I/we further understand I/we will be contacted as soon as practical as to the medical emergency and be provided with all necessary information related to the medical emergency. Parent/Guardian Signature Date PHOTO/VIDEO CONSENT & AUTHORIZATION I hereby consent that one or more photographs may be taken of my child(ren). I authorize St. William and St. John Neumann parishes to use these photos in any way they deem appropriate. I understand and agree that the use of my child(ren) s picture is not an invasion of privacy. Neither I nor anyone claiming to be speaking on my behalf will later object to the Parishes use of this/these photographs or videos. Parent/Guardian Signature Date For Office Use Only Amount Due $220 Amount Paid Date Received Check #

Confirmation Personal Assessment Due: Sunday, June 12, 2016 Name School How would you describe your prayer life and participation at Mass? What service experiences have you had in the past? How have they impacted your faith life? My past participation in learning about my faith has been What is one goal you would like to set for yourself for this Confirmation process? I would like to attend the following retreat: Oct. 21-23, 2016 Nov. 4-6, 2016 I can attend either retreat The best time of day for me to attend small group meetings is: Sunday morning, sometime between 8:30 a.m. and noon Sunday afternoon, sometime between noon and 5 p.m. Sunday evening, sometime after 5 p.m. My preferred meeting location is: St. William St. John Neumann (morning only) Offsite Any location is fine Please consider putting me in a small group with the following people: 1. 2. The following is MOST important to me when placing me in a small group: Retreat date Meeting time Meeting location Being with my friends

_ Day Trip Permission/Indemnity PLEASE RETURN BY: Sunday June 12, 2016 Child / Ward: Parish / School: St. William and St. John Neumann Designated Supervisor of Activity: Youth Ministers and Confirmation Team Activity: Multi-Cultural Event, Service Day, and all other day trips. Date(s) and time of activity: Multi-Cultural Events on Feb. 5 or 19, 2017; Service Day as agreed upon by small group; other day trips Method of transportation: Bus or Confirmation Team/Parent drivers Student cost (if applicable): $0 I consent to the participation of my child/ward in the above named activity. In consideration for my child/ward s participation, I agree to reimburse and indemnify the parish/school (understood to include the Archdiocese of Milwaukee) for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that I or my child/ward may bring against the parish/school which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found legally liable for injuries sustained by child/ward, this paragraph will not apply. I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that I may have had. Parent / Legal Guardian Signature Address Date / Home phone/cell phone This form has been prepared by and is required by The Archdiocese of Milwaukee s Protected Self- Insurance Program. Questions should be directed to Catholic Mutual Group at 262 255-6906.

PLEASE RETURN BY: Sunday, June 12, 2016 Overnight Confirmation Retreat: Oct. 21-23 OR Nov. 4-6, 2016 Retreat Permission/Indemnity Participant s Name: Birth Date: Gender: M F Parent/Guardian s Name: Home Address: Home Phone: Cell Phone: I,, grant permission for my child, to participate in this parish youth ministry event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from the Confirmation team at St. William and St. John Neumann. Event: Overnight Confirmation retreat Destination: Camp Whitcomb/Mason, Hartland, WI Individuals in Charge: Julie Dennert and Joann Nelson Estimated departure/return: Friday, 6 p.m. to Sunday 2 p.m. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ( participant. ) I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the parishes of St. William and St. John Neumann, their officers, directors and agents, and the Archdiocese of Milwaukee, chaperones, or represented associated with the event for reasonable attorney s fees and expenses arising in connection therewith. Signature Date: MEDICAL MATTERS: I hereby warrant that 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 that are applicable.) 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, if you are unable to reach me at the above numbers, contact: Emergency contact Name and Relationship: Phone: (home) (cell) Family Doctor: Phone: Family health plan carrier: Policy #:

Other medical treatment: In the event it come to the attention of the parish, its officers, directors and agents and the Archdiocese of Milwaukee, chaperones, or representatives association with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever or diarrhea, I wish to be notified if deemed appropriate by retreat staff. Signature: Date: Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage are as follows: Signature: Date: No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life threatening and emergency treatment is required. Signature: Date: I hereby grant permission for non-prescription medication (such as Tylenol/ibuprofen, throat lozenges, tums) to be given to my child if deemed appropriate. Signature: Date: Specific Medical Information: The parish will take reasonable care to see that the following information will be held in confidence. Allergic Reactions (medications, foods, plants, insects, etc): Date of last tetanus/diphtheria immunization (DpT or TDap) Does child have a medically prescribed diet? Any physical limitations: Is child subject to homesickness, emotional reactions to new situations, sleepwalking, bedwetting or fainting? Has child recently been exposed to contagious disease or conditions (i.e. mumps, measles, chickenpox?) If so, date and disease or condition: Be aware of the following medical conditions of my child:

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