Confirmation Retreat Registration

Student Information

(preferred name)
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Address Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Birth Date (mm/dd/yyyy) REQUIRED
Please type birth date in mm/dd/yyyy format
Please fill out this field. Please enter a date.

Parent Information

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.

Retreat Information

The retreat begins at 8:30am and ends after the 4:30 pm Mass. Please select your preferred date REQUIRED February 14, 2026 February 21, 2026 Please fill out this field.
Please select t-shirt size. They are ADULT sizes REQUIRED Please fill out this field.
Student Lunch Preference
We will be having boxed lunches for lunch, choose your preference below. REQUIRED Ham Sandwich Turkey Sandwich Vegetarian Option Please fill out this field.
Explain below if there are dietary restrictions we need to know about

Chaperones

Count me in as a Chaperone (need 8-10)
All Chaperones must complete Diocese FWSB Safe-Environment training prior to retreat
Yes!
For this retreat, I am in need of 8-10 adults who are willing to Chaperone/help with various aspects of this event. It is important to have adult help to make this event worthwhile and meaningful for the students. Thanks in advance for your wiliingness to help out. If you are interested in helping please fill out the information below.
Chaperones will need to be Diocese Safe Environment Certified. Please check one: I have completed the FWSB Diocese Safe Environment training and certification within the past 5 years I have not completed the FWSB Diocese Safe Environment Certification within the last 5 years I don't know.
Chaperone First Name Please enter valid data.
Chaperone Last Name Please enter valid data.
Chaperone Email Please enter an email address.
Chaperone t-shirt size. They are ADULT sizes
We will be having boxed lunches for lunch, choose your preference below. Ham Sandwich Turkey Sandwich Vegetarian Option
Explain below if there are dietary restrictions we need to know about

Lunch Help

Statement of Consent and Liability Waiver

By typing my name below I acknowledge that as parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor ("participant"). I aree on behalf of myself, my child named herin, or our heirs, successors, and assigns, to hold harmless and defend St. Elizabeth Ann Seton Parish, its officers, directors, employees and agents, and the Diocese of Fort Wayne-South Bend, its employees and agents, chaperones, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Fort Wayne-South Bend, its employees and agents and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought againt them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.
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 REQUIRED Please fill out this field. Please enter a date.

Retreat Fee

Select one REQUIRED 20.0 – We are parishioners of St. Elizabeth or attend St. Elizabeth School 30.0 – We are not parishioners of St. Elizabeth Please fill out this field.

February 14 or February 21