Antioch

This is your application for the Antioch weekend. The three day experience is the beginning of a lifestyle of sharing your Christian faith at home, school, or wherever you are. Your weekend begins on Friday at 7:30 pm and will conclude on Sunday after the 3:00 p.m. Closing Liturgy. Complete details concerning the Antioch weekend will be sent to you in a future mailing.

The cost of the weekend is $55.00 which includes five meals, snack, souvenir and all the program costs.

IMPORTANT --The application at the bottom of this page must be filled out and returned with the fee in order to be accepted as a candidate for the weekend. All 10th graders must participate in an Antioch Retreat prior to Confirmation next falland must be present for the entire weekend.

Anne Marie Gisoldi, Director of Youth Ministry

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Weekend ofMarch 3- 5:Place –St. Vincent’s, MadisonNew Jersey

Name E-Mail Address: ______

Address Telephone No.: ______

School Grade Age: _____

Parish Catholic Other: ______Medical/Psychological Concerns: ______

Medication being taken: ______

Any Allergies, i.e. medicines, animals etc: ______

HELP IS ALWAYS NEEDED DURING THE WEEKENDS. I CAN HELP:

Serve lunch on Sun. Mar. 5that 11:45 am.

Many parents express an interest in donating food to these retreats. If you are interested in doing this, here are some suggestions:

Veggie platter for Friday evening snack, Mar. 3

______Fruit/cheese platter for Friday evening snack, Mar. 3

Dessert for 10 - Can drop off Friday evening, Mar. 3or Sat. morning

Caesar Salad for 10 for Lunch on Sun.,Mar. 3rd, by11:30 am or at drop off inthe am.

______4- 2 liter bottles of any type of soda

IMPORTANT: Parents and family members should attend the closing liturgy on Sunday afternoon at 3:00 p.m. at St. Vincent’s, NJ. This is a very important part of the weekend. Mark your calendars!

Release of Liability: In consideration of full payment and accepting my/our sons’s/daughter’s registration for this event, I/we release, hold harmless and discharge St. Vincent Martyr and St. Patrick, their officers, trustees, employees, chaperones and other personnel from any and all allegations, liability, claim, loss, damage, cost or expense and wave any such claims against any such person or organization in connection with this event, and I/we further agree to indemnify and hold harmless the Paterson Diocese and its’ aforesaid personnel from any such allegations, liability, claim, loss, damage, cost or expense.

DateParental Signature