Life Teen Men's Lock-In Retreat

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Life Teen Men's Lock-In Retreat 2021

Cost: $25

Includes Friday dinner, Saturday breakfast, & event supplies

Receive a $5 discount when you invite a friend by using the code: INVITE

The goal is for teens to foster a habit of inviting peers to ministry events, and for them to be able to share their experiences with a community of friends. This discount code operates on the Honor System. We hope that our teens see this as an encouragement to make genuine invitations to individuals that they believe will be open to attending.

This Lock-In Retreat will combine retreat elements, such as talks and prayer, with recreation and social time. Our 'Final Details' which will include a packing list, will be sent out 1 week prior.

Participant Information

Teen's Name*

First Name

Last Name

Date of Birth*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Teen's Phone (Optional)

Teen's Email (Optional)

Does your teen attend church or youth ministry somewhere other than St. Timothy?

Leave blank if attending at St. Timothy's

School*

Grade*

9 10 11 12

Please list any special needs/allergies/behavioral needs/medication:/etc. that may be helpful for our chaperones to be aware of:

My son has my permission to receive basic over the counter medication if necessary.*

Yes No

Eg. Pain reliever, Pepto Bismol, Antihistamine, Cough Drops, etc.

Add a second teen?*

Yes No

Please Note: Only one discount code can be applied per form. You will need to complete a separate form for a second teen if you wish to apply the INVITE discount for both.

Participant #2 Information

Teen's Name*

First Name

Last Name

Date of Birth*

Teen's Phone (Optional)

Teen's Email (Optional)

Grade*

9 10 11 12

Please list any special needs/allergies/behavioral needs/medication:/etc. that may be helpful for our chaperones to be aware of:

My son has my permission to receive basic over the counter medication if necessary.*

Yes No

Eg. Pain reliever, Pepto Bismol, Antihistamine, Cough Drops, etc.

Add a third teen?*

Yes No

Please Note: Only one discount code can be applied per form. You will need to complete a separate form for a second teen if you wish to apply the INVITE discount for both.

Participant #3 Information

Teen's Name*

First Name

Last Name

Date of Birth*

Teen's Phone (Optional)

Teen's Email (Optional)

Grade*

9 10 11 12

Please list any special needs/allergies/behavioral needs/medication:/etc. that may be helpful for our chaperones to be aware of:

My son has my permission to receive basic over the counter medication if necessary.*

Yes No

Eg. Pain reliever, Pepto Bismol, Antihistamine, Cough Drops, etc.

Parent Information

Parent (Guardian) #1 Name*

First Name

Last Name

Parent (Guardian) #1 Cell/Home Phone*

Parent (Guardian) #1 Email*

Parent (Guardian) #2 Name

First Name

Last Name

Parent (Guardian) #2 Cell/Home Phone

Parent (Guardian) #2 Email

Are there family situations that you'd like our leaders to be aware of?

Eg. Custody issues, Recent death in the family, etc.

Emergency Contact (Other than listed above)*

First Name

Last Name

Relationship to Teen*

Emergency Contact Cell/Home Phone*

Waiver

I request that the St. Timothy Life Teen program allow my child(ren) named above to attend Life Teen Men's Lock-In Retreat, May 14-15, 2021, at St. Timothy Church in Mesa, AZ. In consideration for my child(ren)'s participation, on behalf of myself, my child(ren), and our heirs, assigns, executors and personal representatives, I hereby release, absolve, indemnify and agree to hold harmless St. Timothy Roman Catholic Parish in Mesa, the Roman Catholic Church of the Diocese of Phoenix, and any and all of their officers, directors, agents, employees, representatives, volunteers, or sponsors from any and all liability for any and all injury and illness that may arise out of participation in this activity. I authorize the supervisor of the retreat or his/her designee to provide first aid or similar care in non-emergency situations and to seek emergency medical assistance when they deem it necessary, for which I will be financially responsible. I understand that transportation will be provided in accordance with the Transportation Policy of the Diocese of Phoenix. I agree to release, absolve and hold harmless St. Timothy Catholic Church for any and all damage sustained to my vehicle should I choose to leave it in the parking lot while attending this event. I give permission to have photographs taken of me/my child(ren), for the purpose of parish use. Should it be necessary for my child or youth to return home due to medical reasons, disciplinary action or otherwise (as determined by youth minister), I understand that I am responsible for picking up my youth or arranging for transportation in a timely manner, and assuming all transportation costs and responsibility. I understand that as a preventive measure and in order to maintain a safe environment, random searches of youths’ personal possessions may be made. I agree that my youth’s personal possessions may be searched when or if a youth minister has reasonable suspicion that a youth may possess an item, including drugs or weapons, in violation of event rules.

For those it pertains to, please refer to our medication policy:

We understand that some teens may at times require medication during overnight/out of town youth ministry events. While we desire to make every effort to assist in the well being of every teen, please understand that the youth leader and core team members are not explicitly trained in this field. We rely on good communication with you, the parents, in order to care for your teen.

All prescription medication must be turned in during the check-in process at the time of departure for trips with an accompanying “Medication Check-In” form which requires a parent signature. This form will be available prior to the event and at the check in process. We do not accept non-prescription medication.
High School teens must be able to administer their own medication and should be able to request their medication from the designated adult leader. Junior High teens are encouraged to be able to administer his/her own medication, but are to be assisted by an adult leader who will provide medication according to the Medication Check-In form.
High School teens who are not able to dispense their own medication, or who require an adult aid in their daily activities, will be required to bring an adult aid (21 years or older) to the event. An adult aid must also complete an event registration and payment.
Our first aid kit includes general over the counter medication, such as pain killers and Benadryl. Permission to administer/receive these medications is requested as part of our standard registration form.

Signature*

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Use your mouse or finger to draw your signature above

Date/Time*

Payment Information

Would you like to donate to a scholarship fund?*

Yes No

Thank you! How much would you like to designate as a scholarship donation?* $

Do you have a discount code?

Yes No

Use: INVITE (case sensitive) to receive $5 off if your son invited a friend

Discount Code:*

Must click on "Apply Discount" to receive the discount

Total $

Credit Card (Pay in Full)*