CONFIRMATION YEAR TWO RETREAT
Event Date: December 5-7, 2025 Event Location: Forest Home Christian Camp Registration Deadline: November 2, 2025
Retreat Registration
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High School Confirmation Candidate
SCDA YTH Retreat Leadership
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Participant Information
Participant Name
*
First Name
Last Name
Participant Cell Phone
Please enter a valid phone number.
Participant Grade
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Please Select
10th
11th
12th
Adult
Participant Shirt Size
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Please Select
Adult Small
Adult Medium
Adult Large
Adult X-Large
Please note: Students tend to prefer to size up for sweatshirts
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Participant Information
Participant Medical Information
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My child/self will be taking prescription medication
My child/self will be taking a non-prescription medication
My son/daughter/self will not be bringing any medications, but I authorize, if needed, Youth Ministry Leaders give my child/self non-prescription, over-the-counter, medications
Medication my son/daughter/self will be taking
Allergies/Medical Problems/Special Dietary Requirements
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Parent/Guardian Information
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Cell Phone
*
Please enter a valid phone number.
Parent or Guardian Email
*
example@example.com
Non-Parent Emergency Contact Name
*
First Name
Last Name
Non-Parent Emergency Contact Cell Phone
*
Please enter a valid phone number.
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Consent Forms
Consent for Photography & Video
I hereby authorize and give full consent, without limitations or reservations, to the Parish of Santa Clara de Asis and the Diocese of Orange to publish any photographs or videos in which the named child(ren), parent(s) or grandparents(s) appear while participating in any program with the Parish of Santa Clara de Asis. There will be no compensation for use or any photographs or videos at the time of publication or in the future.
Consent for Photography & Video
*
YES
NO
Consent for Emergency Release
I, the undersigned, as the parent or legal guardian of the above named child/children, do hereby give permission for him/her/them to participate in any of the activities conducted by in any program with the Parish of Santa Clara de Asis in Yorba Linda, CALIABILITY RELEASE: I also hereby release, forever discharge and agree to hold harmless the Parish of Santa Clara de Asis and the Diocese of Orange and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above named child/children that occur during any program with the Parish of Santa Clara de Asis. Furthermore, I hereby assume all risk and personal injury, sickness, death, damage, and expense as a result of participation in these activities. Further, authorization and permission is granted to furnish any necessary transportation, food, lodging required for the activities. The undersigned further hereby agrees to hold harmless and indemnify the Parish of Santa Clara de Asis, its directors, employees or agents, for any liability sustained by said church as the result of the negligent, willful or intentional acts of the named child(ren), including expenses incurred attendant thereto.MEDICAL RELEASE: I attest that the named child(ren) is/are in good physical condition. Should any accident or illness occur during any program with the Parish of Santa Clara de Asis, I will not hold Parish of Santa Clara de Asis or its directors responsible for medical aid rendered and will reimburse them for the medical and other expenses incurred. The named child(ren) may receive necessary first aid and if necessary medical attention by any duly licensed physician, and may be admitted into a hospital in case of emergency.DISASTER PREPAREDNESS: In case of disaster, my child(ren) may be released into the care of a parent, legal guardian, or the listed emergency contact person(s).
Consent for Emergency Release
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YES
NO
My signature below and the related fields are treated by Santa Clara de Asis Church like a physical handwritten signature on a paper form
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Date Signed
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-
Year
-
Month
Day
Date
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Adult Contributions
As an adult, I am able to contribute in the following ways?
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Provide snacks for the weekend
Sponsor a teen in need of financial assistance
Help organize and sort supplies for the weekend
Join the weekend as our nurse
Help as a support person at the retreat weekend
Pray for the teens + team this weekend
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Retreat Registration Payment
My Products
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( X )
Teen Registration
$
295.00
Adult Leader Donation
Suggested Donation
$
150.00
Will Pay in Office
$
Free
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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