Diocese of Lake Charles

Man Up High School Retreat 2016

at Bear Island in Moss Bluff

(the west end of Bozo Rd.)

Friday, March 4 – Sunday, March 6

This Camp Out Retreat will offer

sporting events including skeet shootingand archery, talks, prayer, Holy Mass & more!

Registration Fee is $70.00

includes shirt, skeet shooting equipment, meals and other supplies

Forms due to the Diocese

by Monday, February22nd.

PERSONAL REGISTRATION

Man Up Retreat

March 4-6

Bear Island Catholic Youth Camp & Retreat Center, Moss Bluff

Please print all information clearly

Teen Information:

Name ______

Mailing address ______

City______Zip______Grade ______

Email Address: ______

mobile Number (if want a text message reminder) ______

CHURCH PARISH: ______

T-shirt size______

Parent Information:

Mother’s Name ______

Father’s Name ______

Best Contact Info:

Email Address: ______

Phone Numbers ______or ______

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.

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: ______Phone Number: ______

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.

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.

5)No guns or archery equipment are permitted on the premises except those provided by staff for skeet shooting activity.

6) No unauthorized or unsupervised use of guns or archery equipment are permitted.

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

If your Child takes DAILY Medication

HAVE THIS FILLED OUT AND READY TO GO WHEN YOU DROP YOUR CHILD OFF.

Name: ______

ADDITIONAL MEDICAL NEEDS:

  1. Please note any medial concerns and the procedure we should follow:

______

  1. Any allergies we need to be aware of: ______

______

  1. Are there any medicines your child cannot take? ______

Medication of Participant:

Please list any medicines your child takes on a regular basis andwill need to be given at camp. List the Name of the medicine(s) and the time(s) given in the appropriate column. We administer all prescription medications to participants while at camp.

Example:

Name of Medicine / AM Dose / Mid-Day Dose / PM Dose
Antibiotic / Takes 2 at 9 AM / Takes 2 at 2 PM / Takes 2 at bedtime
Ritalin / Takes 1 after breakfast / N/A / N/A
Name of Medicines / AM Dose / Mid-Day Dose / PM Dose

NOTE: We also have a first aid station in which your child can receive regular medicines such as pain relievers, sinus medicines and stomach medicines as needed.

Any additional comments:

Man Up is held at Bear Island Catholic Youth Camp and Retreat Center in Moss Bluff.

Directions from Lake Charles

Drive North on HWY 171.

Turn west/left 1.1 miles on Sam Houston Jones Pkwy.

Turn left onto Reeves Rd.

Drive south for .5 miles.

Turn right onto Bozo Rd.

Bear Island Catholic YouthCamp is at the end of the road.

Directions from Westlake:

Drive North on HWY 378.

Cross the Westlake draw bridge.

Continue east 2.1 miles on Sam Houston Jones Pkwy.

Turn right onto Reeves Rd.(by the Pentecostal church)

Drive south for .5 miles.

Turn right onto Bozo Rd.

Bear Island Catholic YouthCamp is at the end of the road.

Man Up is open toHigh school boys of any faith denomination. Registration starts at 5pm Friday and pick up is at 10am Sunday.

We will celebrate Anticipated Mass so yourSunday obligation will be fulfilled.

Registration forms and check made outto Diocese of Lake Charles can be mailed to:

Diocese of Lake Charles

C/O Milissa Thibodeaux

411 Iris Street

Lake Charles LA 70601

Things to bring:

Tent

Sleeping gear

Flash light

Lawn chair

Rosary

Bible

Weather appropriate clothes

Staff contact number

Robby Alleman

337-884-6822