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Peer Ministry Retreat

registration for Peer ministry retreat-sept. 26, 2021
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  St. John the Evangelist CRUSH Youth Ministry is holding its annual Peer Ministry Retreat on Sunday, Sept. 26, 2021 at the Bartlett Nature Center from 9:00am until 8:30pm. All High School Sophomore through Senior year students are welcome!.
  
  Student Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  List any allergies, medications, medical issues, physical activity limitations that your teen cannot take part in AND/OR any other important information. Please enter valid data.
  
  Current Medications Please enter valid data.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physican's Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy in the Name of REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Policy Number REQUIRED Please fill out this field. Please enter valid data.
  
  Identification Number REQUIRED Please fill out this field. Please enter valid data.
  
  T-shirt Size REQUIRED Please fill out this field. Please enter valid data.
  
  By checking this box I hereby agree to all of the following statements: Please select this field.
  
  I hereby give permission for my son/daughter, named below, to participate in the Peer Ministry Retreat held at the Bartlett Nature Center.
  
  I understand that transportation to this event will need to be provided by the parent or other adult to drive the retreatant to and from the Bartlett Nature Center in Bartlett, IL.
  
  I also understand that my child will be under supervision and that all adult leaders from the Parish will be in full compliance with the requirements and policies of the Archdiocese of Chicago's Office for the Protection of Children and Youth.
  
  I understand that if my child violates any laws regarding possession of alcohol or drugs, or rules governing the event, I will be expected to retrieve my son or daughter from the event as soon as possible.
  
  I authorize St. John the Evangelist Catholic Church and the Archdiocese of Chicago to use photographs/videos of my teen for productions, publications, website, and Facebook, Twitter, or Instagram.
  
  Registration Fee35.0
  
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St. John the Evangelist
Catholic Church and School

Streamwood, IL

Peer Ministry Retreat

registration for Peer ministry retreat-sept. 26, 2021