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Retreater Application

- Spiritual Growth

Thank you for prayerfully considering attending BA 17 on October 26th-28th, 2018.

The retreat cost is $32 and is due as soon as possible. If you need a scholarship to help pay the cost, we can help you out. Check the box on the application below. Make checks payable to "Bear Awakening" OR you can pay online here. We also take cash after Mass.

God bless!

E-mail awakening@baylorcatholic.org for any questions.
Retreater Application
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Preferred name (if different from 1st name) Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Scholarship I would like help paying for the retreat. Please contact me about a scholarship.
- Emergency Contact Info
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Retreater REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  
  Insurance Provider Please enter valid data.
  
  Insurance ID# Please enter valid data.
  
  Insurance Member Services Phone# Please enter a phone number.
  
  If you don't have your insurance information available now, please find that information and send it to us as soon as possible.
- Permanent Address REQUIRED Please fill out this field.
- School/University REQUIRED Please fill out this field. Please enter valid data.
- Graduation Year REQUIRED Please fill out this field. Please enter valid data.
- Major REQUIRED Please fill out this field. Please enter valid data.
- Religion/Denomination REQUIRED Please fill out this field. Please enter valid data.
- Home Parish/Church Please enter valid data.
- Birthday REQUIRED Please fill out this field. Please enter a date.
- T-shirt Size REQUIRED Please fill out this field.
- Any Special Food Requirements? Please enter valid data.
- My Favorites....
  
  Color REQUIRED Please fill out this field. Please enter valid data.
  
  Book REQUIRED Please fill out this field. Please enter valid data.
  
  Movie REQUIRED Please fill out this field. Please enter valid data.
  
  Song REQUIRED Please fill out this field. Please enter valid data.
  
  Hobby REQUIRED Please fill out this field. Please enter valid data.
  
  Candy REQUIRED Please fill out this field. Please enter valid data.
  
  Snack REQUIRED Please fill out this field. Please enter valid data.
  
  Saint Please enter valid data.
  
  Bible Verse REQUIRED Please fill out this field. Please enter valid data.
  
  Way to Pray REQUIRED Please fill out this field. Please enter valid data.
  
  Prayer REQUIRED Please fill out this field. Please enter valid data.
  
  Quote Please enter valid data.
- How did you hear about Bear Awakening? REQUIRED Please fill out this field. Please enter valid data.
- Do you know any staffers or retreaters on BA17? If so list their names. Please enter valid data.
- Is there anything else you would like us to know about you?
- Assumption of Risk
  It is recognized and acknowledge by the individual agreeing to this instrument and St. Peter Catholic Student Center and the Roman Catholic Diocese of Austin that certain risks of harm are inherent in the various activities over which the sponsors have no control. By way of enumeration and not limitation, some examples are injuries one may receive on trips by falls, bad weather or actions or activities of other participants. In recognition of these facts and understandings and of the legal relationship between partcipant and the sponsor of the activities, the following acknowledgement of agreement is made. For and in consideration of the agreements and understandings here made I agree to assume all risks and responsibility for any and all claims for damage, including personal injury or death, medical expenses, disability, lost wages, loss of earning capacity, and property damages which may be incurred by participant while engaged in Bear Awakening #17, October 26-28, 2018 sponsored by St. Peter Catholic Student Center or employees or staff of the same. I have read the above and foregoing and have willing signed the same with a full understanding of its purpose. I am above the age of 18 years and otherwise competent to execute this statements.
  I Agree Please select this field.
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