Confirmation Packet 2013.pdf - Flocknote

DIOCESE OF CORPUS CHRISTI
620 Lipan St.
Corpus Christi, Texas 78401
(361) 882-6191
Fax (361) 693-6737
Evangelization & Catechesis Department www.diocesecc.org/confirmation
Office of Youth Ministry YouthOffice@diocesecc.org
DIOCESAN CONFIRMATION RETREAT
St. Joseph - Alice, TX
February 16, 2013
St. Peter, Prince of the Apostles - Corpus Christi, TX
March 2, 2013
John Paul II High School – Corpus Christi, TX
March 16, 2013
Every year, the Diocesan Youth Ministry Office sponsors a Diocesan Retreat for those parishes that are unable to
conduct their own retreat or for those candidates that missed their parish confirmation retreat.
Therefore, we will be hosting three separate day retreats that candidates and their sponsors may choose from. The
group registration form must be completed by the Pastor, Director of Religious Education, or Youth Minister of the
parish.
The total cost of the day retreat is $40 for both candidate and sponsor. This is to cover the retreat expenses
including lunch. The deadline for the February 16 th retreat is Friday, February 8 th . The deadline for the March 2 nd
retreat is Friday, February 22 nd . The deadline for the March 16 th retreat is Friday, March 8 th . Space is limited so
seats are confirmed with the first paid group registration forms until seats are full.
Late registrations will not be accepted. Attached consent and liability forms will also be required to participate in
the Diocesan Confirmation Retreat. There is an Adult Participation form to be completed by the sponsor. Sponsors
are required to attend the retreat with their candidate. If a sponsor can’t attend, a proxy must attend (such as one of
the parents or guardians).
For more information, you may e-mail Heath Garcia at YouthOffice@diocesecc.org.

Diocesan Confirmation Retreat
“Who do people say that I am?” Mark 8:27
February 16, 2013
Parish Group Registration Form
St. Joseph Church
801 South Reynolds, Alice, Texas 78332 – Parish Hall
Registration begins at 8:00 am; Retreat is 8:30am – 4:30 pm
Open to Confirmation Candidates & their Sponsors
Parish: ________________________________________ City: __________________________
Adult Leader: _________________________________________________________________
Phone: _________________ (hm / wk / cell) Alt. Phone: __________________ (hm / wk / cell)
Email: _____________________________________ Address: __________________________
City: __________________________________________ Zip: __________________________
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Candidate Name Age/Grade
Candidate
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Sponsor’s Name Sponsor’s cell #
Each candidate’s & Sponsor’s cost is $20 each, which includes lunch, snacks, and retreat expenses
Total Fees Submitted in this Packet__________
Please return form with a single check payable to “Diocese of Corpus Christi”:
Youth Office / 620 Lipan St. / Corpus Christi, TX 78403
Phone: 361-882-6191 Email: YouthOffice@diocesecc.org Website: www.diocesecc.org/confirmation
Registration Deadline for February 16 th Retreat: Friday, February 8, 2013, 5:00pm
Sponsors are required to attend the retreat with the Confirmation Candidate
Late registrations will not be accepted

Diocesan Confirmation Retreat
“Who do people say that I am?” Mark 8:27
March 2, 2013
Parish Group Registration Form
St. Peter, Prince of the Apostles Church
3901 Violet Road, Corpus Christi, Texas 78410 – St. Matthew’s Hall
Registration begins at 8:00 am; Retreat is 8:30am – 4:30 pm
Open to Confirmation Candidates & their Sponsors
Parish: ________________________________________ City: __________________________
Adult Leader: _________________________________________________________________
Phone: _________________ (hm / wk / cell) Alt. Phone: __________________ (hm / wk / cell)
Email: _____________________________________ Address: __________________________
City: __________________________________________ Zip: __________________________
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Candidate Name Age/Grade
Candidate
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Sponsor’s Name Sponsor’s cell #
Each candidate’s & Sponsor’s cost is $20 each, which includes lunch, snacks, and retreat expenses
Total Fees Submitted in this Packet__________
Please return form with a single check payable to “Diocese of Corpus Christi”:
Youth Office / 620 Lipan St. / Corpus Christi, TX 78403
Phone: 361-882-6191 Email: YouthOffice@diocesecc.org Website: www.diocesecc.org/confirmation
Registration Deadline for March 2 nd Retreat: Friday, February 22, 2013, 5:00pm
Sponsors are required to attend the retreat with the Confirmation Candidate
Late registrations will not be accepted

Diocesan Confirmation Retreat
“Who do people say that I am?” Mark 8:27
March 16, 2013
Parish Group Registration Form
John Paul II High School
3036 Saratoga Blvd., Corpus Christi, Texas 78415 – Cafetorium
Registration begins at 8:00 am; Retreat is 8:30am – 4:30 pm
Open to Confirmation Candidates & their Sponsors
Parish: ________________________________________ City: __________________________
Adult Leader: _________________________________________________________________
Phone: _________________ (hm / wk / cell) Alt. Phone: __________________ (hm / wk / cell)
Email: _____________________________________ Address: __________________________
City: __________________________________________ Zip: __________________________
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2.
3.
4.
5.
6.
7.
8.
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10.
Candidate Name Age/Grade
Candidate
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2.
3.
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5.
6.
7.
8.
9.
10.
Sponsor’s Name Sponsor’s cell #
Each candidate’s & Sponsor’s cost is $20 each, which includes lunch, snacks, and retreat expenses
Total Fees Submitted in this Packet__________
Please return form with a single check payable to “Diocese of Corpus Christi”:
Youth Office / 620 Lipan St. / Corpus Christi, TX 78403
Phone: 361-882-6191 Email: YouthOffice@diocesecc.org Website: www.diocesecc.org/confirmation
Registration Deadline for March 16 th Retreat: Friday, March 8, 2013, 5:00pm
Sponsors are required to attend the retreat with the Confirmation Candidate
Late registrations will not be accepted

Diocese of Corpus Christi/ Office of Youth Ministry
Parish: _____
Diocesan Confirmation Retreat
PARENTAL/GUARDIAN CONSENT, LIABILITY WAIVER AND
MEDICAL CONSENT
Participant’s Name Date of Birth
Home Address
City Zip Code
Parent(s)/Guardian(s)
Home Phone (___)
Alternate Phone Number: (___) Cell Phone _____________
Parish or Catholic School Grade ____ Age____ Sex___
CONSENT & 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) ____________________________________________, grant
permission for my child, (participant’s name) ,
to participate in Diocesan Confirmation Retreat to be held February 16 th , 2013 at St. Joseph
Church, in Alice, Texas, March 2 nd at St. Peter, Prince of the Apostles Church in Corpus Christi,
Texas and March 16 th at John Paul II High School, Corpus Christi, Texas.
I agree on behalf of myself, my child’s other parent if known or living (name of parent)
, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Diocese of
Corpus Christi, the sponsoring parish (its pastor, youth minister, principal, other agents, etc.) or any representatives
associated with the scheduled activity unless the parties involved were careless or negligent.
_____________________________________________ ______________________
Signature (Parent/Guardian) Date
_______________________________________________ ______________________
Signature (Participant 18 years of age or older must sign own consent) Date
PHOTOGRAPHY/VIDEOGRAPHY CONSENT
As parent/guardian, I understand that promotional pictures (individual and group) will be taken during this
event. I give permission for my son’s/daughter’s picture to be used for promotional materials (newsletter, web
page, calendars, power point, video, etc.) in highlighting the event.
__________________________________________________ ______________________
Signature (Parent/Guardian) Date

MEDICAL CONSENT
Medical Matters
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the
health of my child. Of the following statements pertaining to medical matters, sign only those in accordance with
your wishes:
Emergency Medical Treatment
In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or
surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
In the event of an emergency and you are unable to reach me, contact:
Name & Relationship _________________________________ Phone ___________________________
Family Doctor ______________________________________ Phone___________________________
Medications
My child will bring all such medications, well labeled, that are necessary. Names of medications and concise
directions for seeing that the child takes such medications, including dosage and frequency is as follows
My child is taking the following medication at the present time.
Medication(s): ________________________________________________ Dosage: _____________________
Administer: _____________________________________________________________________________
_____ I hereby Do Not Grant Permission for medication of any type, whether prescription or nonprescription may
be administered by my child unless the situation is life threatening and emergency treatment is required. (Please
initial)
_____I hereby Grant Permission for nonprescription medication (such as Tylenol, throat lozenges, cough syrup) to
be given to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter. (Please
initial)
Medical Conditions Information
(Diocesan personnel will take reasonable care to see that the following information will be held in confidence.)
My son/dau Seizures
Allergic reactions to the following (foods, dyes, latex etc.) ___________________________________________
Has had a medical surgery within the last six months? Yes No Still under doctor’s care? Yes No
Has a medically prescribed diet? _______________________________________________________________
The following physical limitations? _____________________________________________________________
Immunizations current and up to date: Yes No Date of last tetanus/diphtheria immunization ________
You should also be aware of these special medical conditions of my child: _____________________________
________________________________________________________________________________________
Insurance Information
(Please attach a copy of the Insurance Card, front and back, with this form)
Insurance Carrier:
Name of Insured:
Insurance Policy Number:
Father’s Name: Day Phone:
Mother’s Name: Day Phone:
No, I do not carry medical insurance at this time.
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.
_______________________________________________ __________________
Signature (Parent/Guardian) Parent/Guardian must sign for anyone under 18 years of age. Date
____________________________________________________ __________________
Signature (Participant 18 years of age or older must sign own consent) Date

Diocese of Corpus Christi and/or Parish of
___________________________
Youth Ministry Release of Liability and Medical Release Form
Adult Participant’s
Name:________________________________________________________________
Parish:_______________________________ Daytime Phone #___________________________
Address:____________________________________________________________________________
City:_____________________________________________State:____________________Zip:______
I agree on behalf of myself, my heirs, successors, executors, personal representatives and assign to protect,
indemnify, save, and hold harmless the Diocese of Corpus Christi, and ____________________ parish , and their
officers, directors, agents employee, or representatives associated with this event/trip from all damages, claims,
suits, expenses and payment on account of or resulting from conditions stated on or resulting from any such injury,
death, or damage to property, including resulting from the negligence of the Diocese of Corpus Christi, and parish,
and/or their officers, directors, and employees arising from or in connection with my attending youth ministry
events beginning through . In the event that any legal action is taken by either party against the other party to
enforce any of the terms and conditions of this agreement, it is agreed that the unsuccessful party to such action
shall pay to the prevailing party therein all court costs, reasonable attorneys fees and expenses incurred by the
prevailing party. In the event that I should require medical treatment and am not able to communicate my desires
to attending physicians or other medical personnel, I give permission for the necessary emergency treatment to be
administered. Please advise the doctors that I have the following allergies:
____________________________________________________________________________________
In case of an emergency and for permission for treatment beyond emergency procedures, please contact:
Name:______________________________________________________________________________
Relationship to me:___________________________________________________________________
Day Time Phone #:______________________Night Time Phone #___________________________
Health Insurance Carrier:_____________________________________________________________
Insurance ID Number:__________________ Insurance Policy Number:_______________________
____________________________________________________________ _____________________________________________________
(Signature) (Date)