Kairos Retreat Application Form for Juniors & Seniors in High School

Kairos Retreat Application Form

for Juniors & Seniors in High School

Diocese of Joliet, Office of Youth Ministry

16555 Weber Road, Crest Hill, IL 60403
Date: Kairos 10: Tentatively December 1-3, 2017

(location Our Lady of Angels Retreat Center, Lemont)

All retreats start punctually at 7pm on Friday and conclude at 5pm on Sunday.

The following application and permission form, with payment of $100 (made out to Diocese of Joliet) are due no later than 2 weeks prior to the event. Deadlines are posted on the retreat flyer. The size of the retreat is limited to 30 participants to insure a good experience, and priority will be given to those who register early.

Personal Information

First and Last Name

Street Address

City Zip

Teen email Teen Cell phone

Parent Name(s)

Parent(s) email(s)

Parent(s) phone(s)

School/City Grad. Yr

Parish/City________________________________________________________

Guidelines and Expectations

Please initial to signify that you meet the guidelines and will adhere to the expectations.

I am a junior or a senior in high school.

I will participate in all group activities.

I will not leave the facility during the retreat.

I will respect the property we will be using, as well as the property of others.

I will not bring any electronic devices such as my cell phone, iPod, camera, laptop, games, etc.

Alcoholic beverages & drugs of any kind are not allowed, and will not be tolerated.

My signature below confirms my agreement with the preceding terms.

Applicant Signature Date

Return this form with the permission form and payment of $100 to:

Diocese of Joliet, Office of Youth Ministry, 16555 Weber Road; Crest Hill, IL 60403

Questions or concerns: Contact the Youth Ministry Office at 815-221-6234 or email [e-mail]