St. Maximilian Kolbe Catholic Community
Confirmation Retreat
March 20-22, 2015
This is a weekend retreat to help form community, to better understand and appreciate yourself, others, and God. A team of youth and adults who have already experienced this retreat will give the retreat.
FOR WHOM: This is a required retreat for all 11th graders and is part of Confirmation Preparation program at the Camp Allen Retreat Center in Navasota, TX
.
WHERE: Camp Allen Retreat Center in Navasota, TX. Address and map is attached.
DATES AND TIMES: March 20-22, 2015
Check-in will be at Camp Allen Retreat Center in Navasota, TX at 7:30 p.m. on Friday, March 20, 2015. Transportation is on your own. Please pick your child up on Sunday by 10:00 a.m., so that we can all meet back at St. Maximilian, to celebrate the 11:30 a.m. Mass together.
TRANSPORTATION: Each person is responsible for his or her own transportation. Please remember that no youth is permitted to drive by themselves to and from the camp. Thank you for your understanding.
MEALS: There will be NO dinner served on Friday. Breakfast, lunch and dinner will beserved on Saturday. Sunday breakfast will be provided before leaving camp. Please bring a snack to share!
COST: The fee for the retreat is $130.00 due at registration.
REGISTRATION: The attached Registration/Medical Release form must be completed and signed by a parent or guardian. The completed form, along with the fee, is due no later than March 1, 2015. Please submitthe form with the fee to Joanna Abbodandolo at St. Maximilian Kolbe Catholic Community, 10135 West Road, Houston, Texas, 77064, or drop it by the Youth Office. Space is limited and registration will be on a first come, first served basis.
RULES: All registered youth must be present for the entire retreat. Should behavior of a youth be judged unacceptable by the adult retreat team, a parent will be called to pick up the youth.
BRING: A sleeping bag, bed linens and a pillow;toweland toiletries; and a snack to share. Please bring any medication in the original, labeled container that may be needed on the retreat. This includes Advil or Tylenol. Allmedications, including non-prescription medications, should be listed on the registration/Medical Release form, and must be turned in to the Retreat Team, upon arrival at camp. Medications will be dispensed as noted on the Medical Release Form, by the parent(s).
DO NOT BRING: Weapons of any kind (i.e.: air-soft guns, hunting knives etc.) tobacco of any sort, illegal drugs or drug paraphernalia. The first goal of a retreat is to withdraw from our everyday world to focus on deepening our faith experience and we need everyone to comply in order to do so.
QUESTIONS: Please contact Joanna Abbondandolo at 281-955-7324, extension 103.
In case of emergency, 713-594-0665 (Joanna’s cell)
Diocese of Galveston-Houston / Office of Youth Ministry
St. Maximilian Kolbe Catholic Community
PARENTAL/GUARDIAN CONSENT, LIABILITY WAIVER
AND MEDICAL CONSENT
Participant’s Name______Date of Birth
Home Address
City Zip Code
Parent/Guardian Home Phone (___)
Alternate Phone Number: (___)Cell Phone
Parish Grade Age Sex_____
Registrations received within the week prior to the retreat are not assured of t-shirt size <
CONSENT AND LIABILITY WAIVER
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(event)
ConfirmationRetreat_ to be held (date) March 20-22, 2015
at (location) Camp Allen Retreat Center in Navasota, 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 hold harmless and defend the Diocese of Galveston-Houston, the sponsoring parish (its pastor, youth minister, other agents, etc.) or any representatives associated with the scheduled activity unless the parties involved were careless or negligent.
______
Signature (Parent/Guardian) Date
______
Signature (Participant 18 years of age or older must sign own consent) Date
PHOTOGRAPHY CONSENT
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, etc.) in highlighting the event.
______
Signature (Parent/Guardian) Date
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 even of an emergency and you are unable to reach me, contact:
Name & Relationship: ______Phone: ______
Family Doctor: ______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 is as follows
My child is taking the following medication at the present time.
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 non-prescription 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.)
My son/daughter has: ______
Has had an episode the following or has been diagnosed: □Seizures□ Asthma□ Diabetic
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: ______Insurance Policy Number: ______
Name of Insured: ______Insurance ID Number:______
Father's Name: ______Birth Date: ______
Place of Employment: ______
Mother's Name: ______Birth Date: ______
Place of Employment: ______
□ 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, 1 want to be called immediately.
I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.
______
Signature (Parent/Guardian) Parent/Guardian must sign for anyone under 18 years of age. Date
______
Signature (Participant 18 years of age or older must sign own consent) Date
Teen Creed
This Creed is a reminder that I must follow not only the rules of God,
but also the rules of the program .
We want to do our best to behave in the way Jesus taught us, “Treat others the way you would want them to treat you.”
I will help others and treat them with respect. I will be a good example.
I will be respectful of others in what I say. I will speak to others or talk about others only in the way I would want them to do with me. Calling names, "put down" remarks, false accusations, threatening others is disrespectful.
I will be polite and use good manners. I will take my own place in line. To push ahead of others is unmannerly. I will say, “Please” and “Thank you.” If I make a mistake and act in a rude manner, I will say, “I’m sorry.”
I will behave in a manner that is safe and non-threatening for myself and others. Physical play or rough housing can be threatening to some people. To push or hit or wrestle with anyone is threatening and dangerous. Running can be dangerous. I will report any illness or injury to the adult in charge at once.
I will behave in a way that will help others to trust me. I will show respect for, listen to and follow the instructions given by adults and young adults. I will ask permission if I need to use a phone. I will stay within the assigned areas.
I will respect all the property atCamp Allen. I will take care of my own trash and dispose of it properly at Camp Allen. I will keep restrooms clean. I will be responsible of any damage I cause here at Camp Allen.
I will wear a provided name tag at all times so that I may be easily identified.
I will not participate in illegal drugs, alcohol, or any other substance activities before, during, or after the program/activity. I understand that on all the grounds of Camp Allen, and while I am in the program or part of any other activities of St. Maximilian Kolbe, there is a Zero Tolerance Policy. Getting caught will result in the proper authorities being contacted and even being asked to leave the retreat and even the program.
______
I UNDERSTAND THE CONSEQUENCES OF NOT FOLLOWING THESE GUIDELINES MAY RESULT IN HAVING A PARENT CALLED TO COME AND PICK ME UP AND EVEN SUSPENDED/ RELEASED FROM THE RETREAT/ PROGRAM.
I HAVE READ ALL OF THE ABOVE GUIDELINES AND AGREE TO FOLLOW THEM.
______
Signature of Teen Date Signature of Parent/ Guardian Date
Houston
Take U.S. Highway 290 (Northwest Freeway) West toward Austin.
Exit at FM 362.
Turn right onto FM 362 and go 6 miles to the "T" intersection at FM 1488.
Turn right onto FM 1488 and go 3 miles to Field Store Community.
Turn left back onto FM 362 and go 6.2 miles to the Camp Allen main entrance (on the left).