Confirmation Retreat September 2019

Posted August 1, 2019

Confirmation Retreat September 21, 2019

September Retreat - Saturday, September 21, 2019, 1pm - 10pm, St. Theresa Catholic Church
  • Youth Information

  • i.e. video games, hiking, sports, stamp collecting
  • Emergency Contact and Medical Information

  • Student Health Information

  • Parent/Guardian Information

  • Parent/Guardian Information 2

  • I, the parent/legal guardian of the youth I have designated above, give permission for my child to attend a Parish Confirmation Retreat at St. Theresa Catholic School, 21370 St. Theresa Lane, Ashburn, VA 20147, Saturday, September 21st, 2019 from 1:00PM to 10:00PM. I understand and acknowledge that participation in the activities involves inherent risks of injury to my child. I do herby agree to release, indemnify and hold harmless chaperones, St. Theresa Parish, Youth Ministers, Volunteers, and the Catholic Diocese of Arlington for any costs or expenses arising out of my child’s participation in the activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activities. I further give my consent that in my absence the above-named minor may be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. Photo/Video: Also, I authorize St. Theresa’s Youth Ministry and the Catholic Diocese of Arlington to use my child's picture or video recording for educational purposes and/or marketing purposes. Parents/guardians who do not wish their child to be photographed or filmed should notify the Religious Education Office in writing. I freely execute this Acknowledgement with full knowledge of its content. I understand that in the event my child becomes ill with a communicable illness during the retreat, I have to make immediate arrangements to retrieve my child from the retreat.
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