Kairos 30 Registration Form
  • July 30 - August 2, 2021

  • Parental Permission and Authorization to Attend:

    We (I) hereby agree and give our (my) permission and authorization for our (my) son/daughter to attend the Kairos Retreat sponsored by Holy Family Parish and agree to the terms and conditions set forth in the following form.

  • Emergency Treatment Authorization: As parent(s), we (I) do hereby authorize the treatment by a qualified and licensed doctor of the student named herein in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach us (me). This release form is completed and signed of our (my) own free will in order to authorize medical treatment under emergency circumstances in our (my) absence.

  • Agreement Regarding Liability: We (I) hereby relieve the Parish, its employees and chaperones from any and all liability for claims arising out of our (my) son's/daughter's participation in this retreat and to indemnify and hold harmless the Parish, its employees and chaperones against any such claims arising out of our (my) son's/daughter's participation in this activity.

  • We (I) have read and understand the terms of this emergency authorization and release form and the Retreat Information Document. In consideration of the opportunity to attend the retreat, we (I) agree to the following: We (I) and our (my) son/daughter will abide by the terms set forth in this permission retreat authorization as a condition to attend the retreat. If our (my) son/daughter violates seriously one or more of the stated rules as set forth by the retreat Director, we (I) agree, upon request, to come get him/her.

  • Emergency Contact Name and Phone Number, if different than parent’s numbers:

  • MM slash DD slash YYYY
  • I have read and understand the rules and agree to comply with them.

  • MM slash DD slash YYYY
  • *Due to the current uncertainty with regard to retreats and Archdiocesan Covid-19 Protocols - we are only requiring a $10 refundable deposit. (As opposed to the regular nonrefundable $100). This is simply to validate your registration.

  • **The date of our retreat is subject to change as a result of the ongoing Covid-19 Pandemic and Archdiocesan Covid-19 Protocols. Everyone currently registered will have the opportunity to transfer their registration to the new date (should this occur) before the general public.

  • This field is for validation purposes and should be left unchanged.

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