You are on page 1of 2

F or m

Childs Name_____________________ I, the parent (guardian) of the above named child, hereby, give my permission for his/her participation in the youth activities named above.
Regional Fall Senior High Retreat @ Shoshone Base Camp

I agree that in the event my child is injured as a result of his/her participation in the above named activities, including transportation to and from these activities, whether or not caused by the negligence (active or passive) of the parish youth activities program or any of its agents or employees, I, hereby, release and discharge the Diocese of Boise, its constituent organizations, including, but not limited to St. Pius X Youth Ministry and St. George Parish Ministries. I am not aware of any medical condition of my child which would render it inappropriate for him/her to participate in such activity. I, hereby, give permission to the physician/nurse selected by the youth activities supervisory personnel when present to render medical treatment deemed necessary and appropriate by the physician/nurse. Person (other than parent) to notify in case of emergency: Insurance Company & Policy_____________ Medical Information__________________ __________________________________ Adult Leader Signature________________ Parent/Guardian Signature______________
Registration Deadline September 30, 2012. If you would like to attend, but havent let us know by the date above, please, contact Jenn Jenson 691-7569

Re le a se

Ca h o li c Y ou t h To ge the r


Please make checks out to FIAT Youth Ministries

planted and built up in Jesus Christ, firm in faith. Colossians 2:7

Items to Bring
Schedule Friday

Departure times to be arranged with each parish.

Please eat before you arrive 7:00 pm Register at Shoshone Base Camp 7:30 pm Retreat Begins Late Night Snack Saturday Retreat Day Sunday Brunch and Closing Arrive back to St. George Church prior to 4pm
Our High School Retreat theme is from Pope Benedicts message to young people for the 26th World Youth Day. ...the Cross often frightens us because it seems to be a denial of life. In fact, the opposite is true! Its is Gods yes to mankind, the supreme expression of his life and the source from which eternal life flows. -Pope Benedict XVI Come and experience the fullness of life, and THRIVE!!!

Good Attitude Clothes for 2 Nights Coat Toiletries Sleeping Bag Pillow Flashlight Bible, Rosary and Journal

Registration Form
Youths Name________________________ Parish______________________________ Address_______________________ __________________________________ Phone________________ School__________________Grade_______ Parent/Guardian Name__________________ Home Phone__________________ Work Phone__________________

Shoshone Base Camp along the Coeur dAlene, River. Driving Directions
Take Interstate 90 to Kingston, Idaho, (WEST of Wallace & Kellogg, Idaho) Take Exit 43, Kingston Turn NORTH on the Coeur d'Alene River Road (NF 9) Travel on the CdA River Road, 6 miles past the settlement of Prichard, Idaho, to milepost 29. Shoshone Base Camp is on your RIGHT


$50 per person includes tshirt

Amount Included:____________________

Ca h o li c Y ou t h To ge the r
Contact Jenn Jenson for more info 691-7569