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Winter Retreat

- Sign up today for the High School Winter Retreat!
  
  Who: All high school teens invited!
  
  What & Where: Camp Hidden Lake
  
  When: February 1-2
  Leaving from the church lower level at 8:00 a.m. on February 1
  Returning Sunday, February 2 in time for the 5:00 p.m. Mass.
  Teens should be picked up after Mass.
  Parents are encouraged to join for the 5:00 p.m. Mass.
  
  Cost: $150
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Parent's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent's Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact's Full Name Please enter valid data.
  
  Emergency Contact's Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Student's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Media Waiver
  
  I authorize my child to be included in publications, websites, or instructional activities, for IHM or the Archdiocese of Atlanta, through photographs, videos, artwork, written work, or statements, in this or subsequent years. REQUIRED Yes No Please fill out this field.
  
  Allergies or Medical Concerns
  
  I do hereby give my permission for my child to engage in the various activities sponsored by Immaculate Heart of Mary Church for the youth group and Confirmation Retreat, by or associated with Immaculate Heart of Mary High School youth programs.
  
  By typing my name in the box I am acknowledging I have read and agree to the above. (Parent signature) REQUIRED Please fill out this field.
  
  I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdiocese and its representatives, successors, supervisors, sponsors, organizers and participants for any injuries in connection with the program named above. I likewise release from my responsibility any person transporting my child to and from any of the activities.
  
  I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein.
  
  I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship.
  
  Furthermore, I/we agree that if the above-named student’s behavior is inappropriate, unsafe and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility.
  
  I/We hereby grant permission for publication of group (two or more persons) photos taken at youth events.
  
  By typing my name in the box I am acknowledging I have read and agree to the above. (Parent signature) REQUIRED Please fill out this field. Please enter valid data.
  
  In addition, please consider sponsoring another teen who is unable to make their retreat payment. During this Lent season, let us continue to support and care for one another in any way we can, most importantly in prayer, as we strive to grow closer to God. Any funds that may be above what is needed to sponsor teens will go into Youth Ministry funds to support future needs. Thank you for any additional help you can give to those in need in our community.
  
  Payment REQUIRED Please fill out this field.
  
  We have also included a donation option if you would like to help support a teen who's family can not pay the full amount. Thank you for your generosity!
  
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