Committee Use Only

Paid $ _______

Trinity’s 2010 Parish Retreat Weekend Registration Form

Friday, August 27 – Sunday, August 29, 2010
NAME(S):
_________________________________________________________________________________________

_________________________________________________________________________________________

Address _________________________________________________________________________________

Phone numbers ___________________________________________________________________________

Email Address ____________________________________________________________________________

Special Dietary Needs (Please let us know any special dietary needs that you or your family may have and
indicate any known food allergies. We will have to carry all the necessary food items with us. We cannot
guarantee what will be available at local shopping centers.)
__________________________________________________________________________________________
__________________________________________________________________________________________

Reservations (This information is needed so that we can adequately prepare meals for those in attendance.)

Number in your group sleeping over: (children under 5 eat/stay free)

__________Friday night (includes Friday dinner and Saturday breakfast and lunch):
$50/person or $150/room w/5 beds

_________ Saturday night (includes Saturday dinner and Sunday breakfast and lunch)
$50/person or $150/room w/5 beds

_________ BOTH nights (includes ALL meals) $290 per room w/5 beds

Specific Rooming Requests or Needs

__________________________________________________________________________________________
__________________________________________________________________________________________

I expect to miss the following meals __________________________________________________________

Number having meals only:

_________ Friday Dinner @ $7 6 to 8 p.m. Eastern Daylight Time (or 5 to 7 Central time)

_________ Saturday Breakfast @ $4 8:30 to 9:30 a.m. EDT following coffee at 7:30 a.m. EDT

_________ Saturday Lunch @ $5 Noon to 1 p.m. EDT

_________ Saturday Dinner @ $10 7 p.m. EDT following Hospitality Hour

_________ Sunday Breakfast @ $4 8:30 to 9:30 a.m. EDT following coffee at 7:30 a.m. EDT

_________ Sunday Lunch @ $5 1 to 2 p.m. EDT following Eucharist at noon EDT (11 a.m. central)
 Committee Use Only
Paid $ _______

*Full Refund Available For Cancellation By August 20, 2010. No Refund Thereafter.

Financial/In Kind contribution:

I would like to contribute __________ to assist scholarship funds and ensure the health of the Trinity Parish Retreat.
(Financial or food related donations greatly appreciated).

Volunteer Activity: please sign up for at least one:

_____ Meal preparation (food preparation, cooking, and serving)
___ Friday
___ Saturday ___ Breakfast ___ Lunch ___ Dinner
___ Sunday ___ Breakfast ___ Lunch

_____ Meal clean up (clearing tables, washing dishes, prepping the kitchen for the next meal)
___ Friday
___ Saturday ___ Breakfast ___ Lunch ___ Dinner
___ Sunday ___ Breakfast ___ Lunch

_____ Cabin duties (Saturday only – helping to prepare cabins for guests arriving on Saturday)

_____ Water sports (assisting Joe Smith with various water activities)
____ Friday _____ Saturday _____ Sunday

_____Children’s Activities (not for the entire weekend – short periods of supervised child play)

_____ Hospitality Suite

_____ Sunday Clean-Up of Camp

Contact information in case of emergency

Name ______________________________________ Relationship to you ____________________

Phone Numbers ____________________________________________________________________________

Additional Information You Want Us To Know

__________________________________________________________________________________________

__________________________________________________________________________________________

Indemnification, Release and Hold Harmless

On behalf of myself and as parent or guardian on behalf of the minor(s) listed above, I hereby indemnify, release and hold
harmless Trinity Episcopal Church, and its agents, employees, clergy and staff, and Joseph Smith and Sydney Smith (vessel
operators), of and from any and all claims, legal or equitable, arising out of participation in the above-referenced retreat,
excluding claims arising out of willful or intentional misconduct.

_______________________________________________
Signatures of Adult Participants Date