Retreat registration template

* Indicates required field

Please register by Wednesday, October 11, 2017.

The cost is _____, which includes transportation to Guelph and back, as well as dinner. Cheques should be made payable to St. Michael's parish.
Payment must be collected before you board the bus. If you are arriving independently, pay ____ upon arrival at the Basilica.

INFORMED CONSENT
By submitting this form, you acknowledge the following:

ELEMENTS OF RISK:
By choosing to participate in the Fall Pilgrimage on October 18, 2017, you are accepting the responsibility for any injury that might occur. You agree to follow all the directives of the pilgrimage supervisors. You agree that no alcohol, illegal drugs, drugs not prescribed for you, or weapons of any kind are to be brought on the pilgrimage. The Diocese of Hamilton will not provide accidental death, disability, dismemberment or medical expense insurance on behalf of the participants in this activity.

Acknowledgement *

I certify that I am 18 years of age or older and I have read, understood, and agreed to the conditions above. I understand that, by participating in the activity described above, I am assuming the risks associated with doing so.

Name *

First

Last

Street Address in Waterloo *

Address line 2 *

Postal Code *

Phone Number *

Email *

School *

Emergency Contact *

Emergency contact phone number *

Known dietary restrictions, drug allergies, or health conditions you want us to know about *

Submit

Fall Pilgrimage 2017

Your family is waiting. See you soon!