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Confirmation Retreat Registration Information & Form

- PREP & Youth

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Confirmation Retreat Information
Our Lady Queen of Heaven Parish Confirmation Retreat will be as follows:
Still subject to change due to Covid-19 restictions.

Boys' Retreat: Friday, Jan 10, 2025 to Sunday, Jan 12, 2025 Held at Camp Karol, 1087 Bozo Rd, Moss Bluff, La 70611.

Girls' Retreat: Friday, Jan 17, 2025 to Sunday, Jan 19, 2025. Held at Camp Karol, 1087 Bozo Rd, Moss Bluff, LA 70611.

Components of both Retreats: Live Music, Talks, Personal Prayer Time, Small Group Sharing and Activities, Large Group Games and Mixers, Adoration, Confession and Mass.

Items to Bring:
- Necessary Personal Items
- Clothes for the weekend (be sure to bring tennis shoes)
- Pillow, sleeping bag or sheets & blanket
- Snacks for the community snack table
- Bible
- Rosary
- Personal Journal (if you have one)
- Other prayer books
There will be downtime during the retreat if teens want to bring musical instruments, basketballs, footballs, volleyballs, other games, etc.

(Retreat fees are covered with registration fees.)
Confirmation Retreat Registration Form
Boys Retreat Jan 10-12, 2025 Yes
Girls Retreat Jan 17-19, 2025 Yes
Personal Information:
Teen's Name REQUIRED Please fill out this field. Please enter valid data.
Church Parish Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Retreatant's Email Please enter an email address.
T-Shirt Size Please enter valid data.
Parental Information:
Parent's Name REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Please fill out this field. 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.
Parent's Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number Best Contact REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Medical Information:
MEDICAL: I hereby warrant that to the best of my knowledge, my child is in good health and I assume all responsibility for the health of my child. In the event of an emergency I hereby give my permission to transport my child to a hospital for emergency or surgical treatment by the hospital or doctor.

In the event of an emergency, if you are unable to reach me at the above numbers, contact:
Emergency Contact: Name REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Family Health Plan Carrier REQUIRED Please fill out this field. Please enter valid data.
Policy Number REQUIRED Please fill out this field. Please enter valid data.
Doctor Name REQUIRED Please fill out this field. Please enter valid data.
Doctor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
If Your Child Takes Daily Medication, please fill in the following:
Retreatants Name Please enter valid data.
Additional Medical Needs:
1. Please note any medical concerns and the procedure we should follow:
2. Any allergies we need to be aware of:
3. Are there any medications your child cannot take?

Medication of Participant:

Please list any Medicines your child takes on a regular basis and will need to be given at camp. List the NAME of the medicine(s) and the TIME(S) given in the appropriate column. We administer all prescription medication to particcipants while at camp.

Example

Name of Medication	AM Dose	Mid-Day Dose	PM Dose
antibiotic	2 at 9am	2 at 2pm	2 at bedtime
Ritalin	1 after breakfast	n/a	n/a

Medication AM Dose Mid-Day Dose PM Dose
Note: We also have a First Aid Station in which your child can receive regular medicines such as pain relievers, sinus medicines and stomach medicines as needed.
Additional Comments
Return Request Email REQUIRED Please fill out this field. Please enter an email address.
After clicking on submit, please go back to the Confirmation Retreat Page and click on the Code of Conduct Link on the right side. Please print it out and sign it. Return it to the Totus Tuus Youth House, 707 W Claude St. Lake Charles, LA 70605, or bring the signed form to the Youth House.

Submit

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Confirmation Retreat Registration Information & Form

Confirmation Retreat Information

Confirmation Retreat Registration Form

Personal Information:

Parental Information:

Medical Information:

If Your Child Takes Daily Medication, please fill in the following:

Additional Medical Needs:

Medication of Participant:

Note: We also have a First Aid Station in which your child can receive regular medicines such as pain relievers, sinus medicines and stomach medicines as needed.