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High School Life Teen Retreat

- Learn & Grow

High School Retreat Coming Soon!
The maximum number of form submissions has been reached. This form is currently not available.
- Complete form for each high school student attending.
- Student First Name REQUIRED Please fill out this field. Please enter valid data.
- Student Last Name REQUIRED Please fill out this field. Please enter valid data.
- Student Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Student E-Mail REQUIRED Please fill out this field. Please enter valid data.
- High School REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Father's First Name Please enter valid data.
- Father's Last Name Please enter valid data.
- Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Mother's First Name Please enter valid data.
- Mother's Last Name Please enter valid data.
- Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- I, (as parent/guardian) grant permission for my child, to participate in all Life Teen events/activities, sponsored by the Saint Simon the Apostle Youth Ministry Office. I/We hereby release and save harmless Saint Simon the Apostle and any and all of its employees from any and all liability for any and all harm arising to my/our son/daughter as a result of any event/activity/trip.
- I Agree Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Please list any allergies or special medical problems that your child may have: Please enter valid data.
- Please list any over the counter medications that you give permission to be administered by an adult to your child: Please enter valid data.
- We believe that both the youth and the Parish benefit from positive recognition. There may be occasions for media coverage including your child(ren) throughout the year. We ask permission to release this type of communication. This could include, but not limited to:
  
  Public Media: Newspaper, TV, Catholic Moment, any other public media. Church Media: Bulletin Boards, Parish Videos, Quarterly Newsletter, any other church media.
  
  Web Based Media: Parish Web Site, Other related ministry and religious web sites.
- I Agree Please select this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
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