Confirmation Retreat at Holy Spirit

September 28, 2019

9:00 AM to 4:00 PM

jesusteachingWe welcome participants from other parishes at our Confirmation Retreat. Please complete the permission form below. If you have any questions, please contact the Director of Religious Education at [email protected]

  • Please enter the full legal name of the child who will be attending.
  • If your child is called by a different name than the first name, please enter it here. For example, if your child's first name is "Nicholas" and prefers to be called "Nick," please enter "Nick" below.
  • Please enter the name of your home parish - the parish where you are preparing for Confirmation.
  • What is the name of the person (e.g. the Director of Religious Education, or other person) who we should notify upon your attendance at the retreat?
  • What is the email address of the DRE (or other) whom we should be notifying?
  • As parent/legal guardian of the participant named above, I give my permission to participate fully in the Confirmation Retreat from 9:00 AM to 4:00 PM on September 28, 2019. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge Bishop of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above described event.
  • As parent/legal guardian of the participant named above, I request that in my absence the above-named minor 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. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.
  • As parent/legal guardian of the participant named above, I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.
  • Are there any medical conditions which may affect the participant’s involvement at the retreat? Are there any known allergies including any allergies to medicine?
  • "I understand and hereby agree to the terms and conditions of the participant’s involvement at the Confirmation Retreat" Please type your name to digitally sign, acknowledging you have read and agree to the above listed waiver.
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