Clone of Winter Retreat 2025

Life Teen Fall Retreat 2025

November 21st-23rd
Who: All high school students are welcome to attend. Space is limited, so we will fill spaces as registrations come in.

When: 6:00pm Friday, November 21st through Sunday, November 23rd. The retreat concludes with a closing Mass at 2pm.

We are thrilled this year to invite parents and familes to our closing mass! So please join us for liturgy at 2pm!

Where: Hiram House Camp. 33775 Hiram Trail, Moreland Hills, OH 44022

Cost: The cost is $130 (early bird pricing) or $145 (after 11/1).

Please note, if the cost of the retreat is a financial burden on your family, financial arrangements can be made. Please contact your youth minister.

Forms are due by November 16th.*

What to Bring: Sleeping gear, toiletries, towels, comfortable clothes, and extra shoes or boots, in case of soggy snowy weather. You may bring snacks and drinks but must be willing to leave them with us at check-in for everyone to share, as these are not permitted in the cabins.

What NOT to Bring: Energy drinks, alcohol, tobacco products, vaping items, illegal drugs and electronics (including cell phones, iPods, computers, etc…) Members of our Core Team will have cell phones in case of emergency.

If you have any questions, contact your youth minister:

Theresa 440-781-7269 or Tammy 330-842-1745

Alex Yates 216-245-3369

Nicky Gutierrez 919-907-0081

*Cancellation Policy:
Cancellations made before November 7th will receive a full refund. Cancellations made after November 7th will receive a full refund minus the cost of the T-shirt, as orders will have already been placed. Cancellations made after November 17th are not eligible for a refund, since lodging and meals will have been paid in advance; however, a partial credit may be applied toward a future retreat.
Were you invited by a retreat Team Member?
Type the name of the team member that invited you to retreat or leave blank if no one specific invited you.
Participant’s Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Teen Cell Phone*
Please enter a valid phone number.
Teen Email*
example@example.com
High School
Grade
Home Parish*
Which Life Teen Program do you primarily attend?
T-Shirt Size*

SmallMediumLargeX-LargeXXL
Do you have another Teen to register?*

NoYes
Participant’s Name (2)

First NameLast Name
Birth Date (2)

MonthDayYear
Gender (2)
Address- Leave blank if same as above (2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (2)
Please enter a valid phone number.
Teen Cell Phone (2)
Please enter a valid phone number.
Teen Email (2)
example@example.com
High School (2)
Grade (2)
Home Parish (2)*
Fill in
T-Shirt Size (2)

SmallMediumLargeX-LargeXXL
Do you have another Teen to register?**

NoYes
Participant’s Name (3)

First NameLast Name
Birth Date (3)

MonthDayYear
Gender (3)
Address- Leave blank if same as above (3)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (3)
Please enter a valid phone number.
Teen Cell Phone (3)
Please enter a valid phone number.
Teen Email (3)
example@example.com
High School (3)
Grade (3)
Home Parish (3)
Fill in
T-Shirt Size (3)

SmallMediumLargeX-LargeXXL
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Home Number
Cell Number*
Parent E-mail*
example@example.com
Emergency Information

(if parent cannot be reached)
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number

Consent and Waivers

For parent/guardian
Photo Release

I/We, the parent(s) of the above listed child(ren), give my/our permission to St. Helen Parish (Newbury, Ohio), St. Francis Parish (Gates Mills, Ohio) and St. Mary Parish (Chardon, Ohio) to publish my/our child’s photo only (no name) in publications/media forms listed below exclusively for the purpose of Parish and its parishioners.

Slideshows, Parish Bulletin, Parish Website, Narthex TV, etc.
First Name
Parent/Guardian Signature: Signature* Date: Date
Consent Form and Liability Waiver

I, as the parent or legal guardian of the above listed child(ren) do hereby grant permission for my child to participate in the Life Teen Retreat. I acknowledge that the aforesaid participant will be involved in physical activities that may cause injury and that there may be risks foreseen and unforeseen. I agree by my signature to release, absolve, indemnify, and hold harmless St. Helen Parish (Newbury, Ohio), St. Francis Parish (Gates Mills, Ohio) and St. Mary Parish (Chardon, Ohio), their employees and agents; The Roman Catholic Diocese of Cleveland; The Bishop of the Roman Catholic Diocese of Cleveland their successors and assigns from any and all liability for injury, medical fees, hospital bills, or doctor bills of aforesaid participant as well as all debts, claims, demands, costs, expenses, damages, actions, and causes of actions -- I waive all claims of any kind against those mentioned.

Parent/Guardian Signature Signature* Date: Date
Authorization for Medical Treatment

I, as parent or legal guardian of the above listed child(ren) do hereby give my consent for St. Helen Parish (Newbury, Ohio), St. Francis Parish (Gates Mills, Ohio) and St. Mary Parish (Chardon, Ohio) staff and the chaperones, or other adult representative, in the event that all reasonable attempts to contact me have been unsuccessful, to seek medical attention and treatment deemed necessary by medical personnel. I give my permission to transfer my child to the nearest hospital.

Our healthcare insurance carrier is
This authorization does not cover major surgery, unless the medical opinion of two other licensed physicians concur on the necessity for such surgery and are obtained before surgery is performed.
Does the teen(s) have any allergies, chronic illness, medical conditions or dietary restrictions? If yes, please describe.
Please list any medications and dosage child(ren) is currently taking:
Parent/Guardian Signature: Signature* Date: Date

Statements of Responsibility

For TEEN participants to read and sign.
TEEN STATEMENT OF RESPONSIBILITY:

I request to participate in the Life Teen Retreat. I understand that by requesting to go, I am promising to cooperate with the retreat team, the Life Teen Core Staff, and the Holy Spirit. I understand that the intention of the retreat is to help form community & to bring me closer to God. I promise to follow instructions & be open. I ALSO REALIZE THAT I MAY NOT BRING OR USE ANY TOBACCO PRODUCTS, ILLEGAL DRUGS, OR ALCOHOL. I UNDERSTAND THAT ENERGY DRINKS, CELL PHONES, WATCHES, IPODS OR ANY ELECTRICAL EQUIPMENT WHATSOEVER, ARE NOT PERMITTED. I HAVE READ AND WILL COMPLY WITH THE “TO BRING/NOT TO BRING LIST.” I UNDERSTAND THAT TO BREAK THE RETREAT RULES OR TO ACT UNSAFELY OR IRRESPONSIBLY WILL RESULT IN MY DISMISSAL FROM THE RETREAT INTO MY PARENTS’ CARE.
Teen Signature: Signature* Date: Date
Teen Signature (if additional teen): Signature Date: Date
Teen Signature (if additional teen): Signature Date: Date

Payment and Submission

Registration Payment*

Teen Retreat Registration - Standard Pricing Product Image

Teen Retreat Registration - Standard PricingPlease adjust quantity for how many teens you are registering.

$145.00 Quantity
Item subtotal:$0.00

FeesThank you for helping us cover processing fees!

$3.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

*Cancellation Policy:
Cancellations made before November 7th will receive a full refund. Cancellations made after November 7th will receive a full refund minus the cost of the T-shirt, as orders will have already been placed. Cancellations made after November 17th are not eligible for a refund, since lodging and meals will have been paid in advance; however, a partial credit may be applied toward a future retreat.
I have read and understand the retreat’s cancellation policy and agree to the terms*

I agree
Should be Empty:

Life Teen Fall Retreat 2025

Consent and Waivers

Statements of Responsibility

Payment and Submission

Payment Methods