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Family Retreat Registration

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- The we are no longer accepting submissions of this form. This form is currently not available.
  
  Parent/Guardian Primary Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Number of Family Members Registering (Members 1-4: Additional Members at a discounted rate.) REQUIRED Please fill out this field.
  
  Family Member 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age (On Date of Event) REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade (On Date of Event) REQUIRED
  Enter the child's grade on the date of the event.
  Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Family Member 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age (On Date of Event) REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade (On Date of Event) REQUIRED
  Enter the child's grade on the date of the event.
  Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Family Member 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age (On Date of Event) REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade (On Date of Event) REQUIRED
  Enter the child's grade on the date of the event.
  Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Family Member 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age (On Date of Event) REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade (On Date of Event) REQUIRED
  Enter the child's grade on the date of the event.
  Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Additional Family Members (Members 5+) Please fill out this field.
  
  Additional Family Member 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age of Date of Event REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade on Date of Event REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Additional Family Member 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age of Date of Event REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade on Date of Event REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Additional Family Member 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age of Date of Event REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade on Date of Event REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Additional Family Member 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age of Date of Event REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade on Date of Event REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Additional Family Member 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  School Please enter valid data.
  
  Age of Date of Event REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade on Date of Event REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Name of Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number of Emergency Contact REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Additional information you would like to share about your family's needs, medical or otherwise.
  
  Video/Photography Consent
  
  As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event. I give permission for my own and my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, calendars, power point, video, etc.) in highlighting the event.
  
  Electronic Signature (Parent/Guardian) REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Signature REQUIRED Please fill out this field. Please enter a date.
  
  Consent and Liability Waiver
  
  Important! To be filled out by the Parent/Guardian for youth under 18 years of age. (If participant is 18 years of age or older, consent must be signed by the individual)
  
  I (name of parent/guardian), REQUIRED Please fill out this field. Please enter valid data.
  
  grant permission for my child, (participant's name), REQUIRED Please fill out this field. Please enter valid data.
  
  to participate in St. Mary of the Expectation's St. Mary of the Expectation Family Retreat to be held on Saturday, March 8, 2025 at St. Mary of the Expectation Catholic Church.
  
  I agree on behalf of myself, my child’s other parent/guardian if known or living,
  
  (name of other parent) REQUIRED Please fill out this field. Please enter valid data.
  
  my child name herein, or our heirs, successors, and assigns and defend the Archdiocese of Galveston-Houston, the sponsoring parish (its pastor, youth ministry leader, principal, other agents, etc.) or any representatives associated with the scheduled activity unless the parties involved were careless and negligent.
  
  In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge.
  
  Date of Signature REQUIRED Please fill out this field. Please enter a date.
  
  Electronic Signature (Parent/Guardian) REQUIRED Please fill out this field. Please enter valid data.
  
  In the event it comes to the attention of the chaperones associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately. If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.
  
  Electronic Signature REQUIRED
  Signature (Parent/Guardian must sign for anyone under 18 years of age)
  Please fill out this field. Please enter valid data.
  
  Date of Signature REQUIRED Please fill out this field. Please enter a date.
  
  Registration Fee (Family Members 1-4)30.0
  
  Registration Fee (Family Members 5+)10.0
  
  Processing Fee2.0
  
  Total:
  
  Submit
  
  Proceed to Payment
- Contact Us
  
  Hannah Richardson
  
  Director of Elementary Faith Formation
  
  281-332-3031 ext. 107
  hannah.richardsonsaintmcc.org
  
  David Harley
  
  Director of Youth Ministry
  
  281-332-3031 ext. 116
  david.harleysaintmcc.org
  
  Terri Ryan
  
  Director of Adult Faith Formation
  
  281-332-3031 ext. 104
  terri.ryansaintmcc.org