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Confirmation Retreat YOUTH Registration

This registration form is for youth attending one of the Confirmation Retreats in Spring 2018.

All fields marked with a red asterisk (*) are required.

Select Confirmation Retreat
Full information about the costs and deadlines for each of these Confirmation Retreat options is available on the Confirmation Retreats page.
Participant
Please list all medications (including over-the-counter or non-prescription drugs) and the reason for taking. All medications must be in the original container that identifies the prescribing physician (if a prescription drug), the name of the medication, the dosage and frequency of administration.
Parent / Guardian Information
IMPORTANT: The parent/guardian authorization form, which must be printed, signed and returned in order to complete registration, will be emailed to the name and email address of the person listed below.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg bmp pdf.
Parents' / Guardians' Covenant
I promise to pick up my child on time from the event in accordance with the diocesan Policy Regarding End of Event Supervision. I authorize an adult in whose care the minor has been entrusted to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment or hospital care, to be rendered to the minor under the general or specific supervision and on the advice of any physician or dentist under the provisions of the Medical Practice Act on the medical staff of a licensed hospital.  I will be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the above-named person pursuant to this authorization. I give my permission for photographs and/or video footage of my child to be used by the Diocese of Newark for promotional purposes (brochures, on diocesan websites, promotional videos, presentations, etc). I hereby give permission for this person to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in this event. I have read and understood the Community Covenant.  I understand that the participant must respect and obey the instructions of the adults in charge and that tobacco, alcohol, illegal drugs, weapons, inappropriate sexual behavior or sexually explicit communications will not be permitted at the event. I understand that the Diocese cannot assume responsibility for valuables or electronic equipment brought to the programs without authorization. I will provide transportation home for the young person if problems occur during this event. I will take no civil action or legal action against the adults in charge of the Diocese of Newark Program.

When you click the Submit button below, you will be redirected to a page with both an online payment option, and instructions for paying by check.