Confirmation Retreat

Lumen Christi is partnering with a coupld Parishes this summer to provide Confirmation Retreats that are open to the whole diocese. Lunch will be provided. The day will consist of testimonies, talks, games, times for small group, lunch and a holy hour.

Adult helpers/Parents are welcome to attend as small group helpers. All adults who attend must be Safe Environment certified through the Diocese. Adults planning on attending please contact us at [email protected]

Location Information

Location Name
Our Lady of Good Counsel Parish
Address
202 W 7th St, Elkton, SD, 57026 US
Directions
Google, Bing, MapQuest

Register Today

Registration Options

Youth Registration ($50.00)
Adult helper ($0.00)
Those adults, who are Safe Environment certified, and wish to help with small groups, may "register" here.

Total

$50.00

Please fill out the below fields with the information of the youth attending

Youth's Name

Sex

Male
Female

Date of Birth

High School Graduation Year

Parish

Phone Number

Please list any food allergies you may have

Emergency information

Parent/Guardian Name

Parent Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Emergency contact relation to you

Family Doctor

Family Doctor's number

Health Plan Carrier

Health Plan Policy Number

Allergies

Is the child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bed wetting, fainting?

Please Explain

Please list any medications the student is on

Please list any physical restrictions the student has

Any other special medical conditions?

Please read through these agreements and check the box below

Parental Consent

I (the parent/guardian), grant permission for my child (participant), to participate in this diocesan event that requires transportation away from the parish site. This activity will take place under the guidance and direction of diocesan employees and/or volunteers. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (participant).

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the parish/school listed above, its officers, directors, employees and agents, and the Catholic Diocese of Sioux Falls, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child's participation or attendance at the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish/school, its officers, directors and agents and the Catholic Diocese of Sioux Falls, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.

I hereby warrant that to the best of my knowledge, my child (participant) is in good health, and I assume all responsibility for the health of my child.

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 event of an emergency, if you are unable to reach me at the numbers at the number listed, contact the emergency contact listed.

In the event it comes to the attention of the parish, its officers, directors and agents and the Catholic Diocese of Sioux Falls, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I understand that I will be contacted.

I have read and agree to the terms above.

Date Field

Please read through each paragraph and check the boxes, if applicable.

My child is taking medication at present. My child will bring all such medications necessary, and such medications will be in their original container. Names of medications and concise directions for seeing that the child takes the medications, including dosages and frequency of dosage are notated above.

Check only if applicable. Must be filled out by the parent or guardian

No medication of any type, whether prescription or non prescription, may be administered to my child unless the situation is life-threatening and emergency treatment is required.

Check only if applicable. Must be filled out by the parent or guardian

I hereby grant permission for non-prescription medication (i.e. non-aspirin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.

Check only if applicable. Must be filled out by the parent or guardian

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

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