Diocese of Lake Charles
Middle School Retreat
6th – 8th Grade
Friday, May 13th– Sunday, May15th,2016
DROP OFF:Friday, May 13@ 7:00 PM
WHERE:Dry Creek Baptist Retreat Center
Dry Creek, LA
PICK UP:Sunday, May 15 @ 2:00 PM
COST:$125.00(Late Fee of $5.00 after due date)
Cost will help cover lodging, meals, supplies and t-shirt. (Checks made payable to Diocese of Lake Charles)
If full amount cannot be made please call Ms Caroline (439-7426 ext. 301) so arrangements for payment can be made.
Things to bring: Rosary, Bible, bedding, towels, personal items, jacket if you are cold natured, snacks to share
Mass will be a part of the retreat; time to be determined.
Please register with your parish youth minister for this event. If you do not have a parish youth minister you can register with the Diocese at 411 Iris Street, Lake Charles, LA 70601
Diocese Due Date Friday, April 29, 2016
PERSONAL REGISTRATION
Dry Creek Retreat Center
Friday, May 13 – Sunday, May 15, 2016
Please print all information clearly
NAME: ______
Mailing Address:______
City______Zip______
Teen’s e-mail:______Phone#______
Best Parent Contact: Name ______#______
CHURCH PARISH: ______
Grade:______Gender:______T-Shirt Size______(Youth or Adult)
Circle one
Cost of Retreat = $125.00 (Includes registration, food and t-shirt)
MEDICAL: 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. In the event of an emergency I hereby give my permission to transport my child to a hospital for emergency 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: ______Number: ______
Family Health Plan Carrier: ______Policy Number: ______
Doctor: Name: ______Number: ______
Diocese Due Date Friday, April 29, 2016
CONTRACT OF BEHAVIOR
1) Taking care of the property of the RetreatCenter and paying for any accidental damage to property.
2) All people – participants, adults, speakers, and diocesan staff are to be treated with respect by everyone else.
3)Maintaining a healthy environment – no mood altering drugs, including alcohol, is to be used by anyone including adults. Prudent precaution will be taken to assure that no one has any mood altering drugs in their possession. Possession of alcohol is grounds for dismissal from the retreat. We provide a smoke-free environment.
4)Maintaining a moral atmosphere – At all times dress, music, dance, language, signs of affection, tone of voice is to be appropriate.
I have read the above responsibilities of participants and as a participant will abide the code of behavior found therein.
______
Signature of Student
______
Signature of Parent
CHAPERONE/STAFF FORM
This form must be turned in with Safe Environment Certificate
Diocese of Lake Charles
Middle School Retreat
6th – 8th Grade
Friday, May 13– Sunday, May 15,2016
Staff Cost (lodging & t-shirt only): $55.00
Please print all information clearly
NAME: ______
Best Contact #______
CHURCH PARISH: ______
Gender:______T-Shirt Size______
CONTRACT OF BEHAVIOR
1) Taking care of the property of the Facility being used and paying for any accidental damage to property.
2) All people – participants, adults, speakers, and diocesan staff are to be treated with respect by everyone else.
5)Maintaining a healthy environment – no mood altering drugs, including alcohol, is to be used by anyone including adults. Prudent precaution will be taken to assure that no one has any mood altering drugs in their possession. Possession of alcohol is grounds for dismissal from the retreat. We provide a smoke-free environment.
6)Maintaining a moral atmosphere – At all times dress, music, dance, language, signs of affection, tone of voice is to be appropriate.
I have read the above responsibilities of a chaperone/staff and as a chaperone/staff member will abide the code of behavior found therein.
Signature ______