Saint Matthew Catholic Church

25 Wilkins Road SW
Winder, GA 30680

770-867-4876

Greater Glory Fall Retreat:
November 3-5

- Religious Ed

Greater Glory Fall Retreat Form
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- All fields are required. You must pay $80 upon registration using our Online Giving payment system. You will need to make a payment in order to complete the registration. Payment must be made online.
  
  Start by entering the name of the student and your family envelope number. If you do not know your number, please call the parish office at 770-867-4876 to obtain.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Family Envelope Number REQUIRED Please fill out this field. Please enter an integer (number).
- Phone Number of Student REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email of student REQUIRED Please fill out this field. Please enter an email address.
- Address of Student REQUIRED Please fill out this field. Please enter valid data.
- Name of parent/guardian responsible for payment. REQUIRED Please fill out this field. Please enter valid data.
- Phone number of parent/guardian responsible for payment. REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email of parent responsible for payment. REQUIRED Please fill out this field. Please enter an email address.
- Name and phone number of emergency contact. REQUIRED Please fill out this field.
- Registration Agreement:
  
  As a parent and / or legal guardian, I remain legally responsible for any personal actions taken by my child. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the parish listed above, the hosting parish, their officers, directors, and agents and the ARCHDIOCESE OF ATLANTA, Georgia, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Atlanta, chaperones, or representatives associated with the event for reasonable attorney's fees and expenses arising in connection therewith. I also agree that my child will be in the care of a legal adult guardian during this event at all times. I/We hereby grant permission for publication of group (two or more persons) photos taken at youth events.
  
  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 Agree Please select this field.
- Code of Coduct Agreement:
  
  I have read the Code of Conduct and understand it, and I will abide by the rules and regulations as outlined therein. I will also abide by all rules established by the adult leaders. In the event that I choose not to conform to these rules, I understand that my parents/guardians will be notified of the infraction and consequences will be assigned.
  I Agree Please select this field.
- List Allergies: Type NO ALLERGIES if there are none. REQUIRED Please fill out this field.
- List Medications: Type NO MEDICATIONS if there are none. REQUIRED Please fill out this field.
- Student Adult Sweatshirt Size REQUIRED S M L XL XXL XXXL Please fill out this field.
- $80 Payment is required to complete this registration. Submit this form then click the link below to go to OnLine Giving. Use your bank account or credit card for payment. VISA and Mastercard gift cards are acceptable forms of payment. All payments must be made online. Choose Retreat Fees fund in OnLine Giving
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Greater Glory Fall Retreat: November 3-5

Greater Glory Fall Retreat:
November 3-5