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Limitless H.S. Winter Retreat 2023

- Faith Formation
  - Adult Faith Formation
    
    Bible Study
    Confirmation Preparation for Adults
    Faith Sharing Small Groups
    M.O.M.S. Group
    (Ministry of Mother's Sharing)
    Rite of Christian Initiation of Adults (RCIA)
    Women’s Prayer Group
  - Preschool-6th Grade Formation
    
    Catch-Up Catechesis for Children
    K-6 Faith Formation Weekly Program
    K-8 Summer Faith Formation Program
    Sunday Preschool Faith Formation
    Vacation Bible School
  - Youth Ministries (7th-H.S.)
    
    College Ministry
    Junior High Youth Ministry
    8th Grade Confirmation
    H.S. Youth Ministry, "The Flock"
    
    H.S. Flock Youth Ministry Permission Form
    H.S. Winter Retreat 2023
    
    High School Boys Small Group Registration
  - Information
    
    Education Commission
    Decree on Child Protection (SafeParish™)
    Education & Formation Staff
    Lambtenders
  - Upcoming Programs/Events
    
    Faith Formation Programs Registration
Downloadable Documents
- H.S. Winter Retreat 2022 Permission Slip
Staff Contact
- Grace Curtis
  
  Coordinator of Youth Ministry
  
  513-489-8815 x737
  grace.curtisgood-shepherd.org

H.S. Winter Retreat 2023 Permission Form
The maximum number of form submissions has been reached. This form is currently not available.
- Who: Teens in grades 9-12 (All are welcome! Bring a friend!)
  When: Saturday, January 14, 2023 (3:00 p.m.) to
  Sunday, January 15, 2023 (at 3:00 p.m.)
  Where: The Tau House - 4523 Park Place, Cincinnati, OH 45217
  Drop off and pick up will be at Good Shepherd.
  Cost: FREE!
  
  Come and join us!
- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Name Please enter valid data.
- Mother's Name Please enter valid data.
- Street 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.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Dad's Cell Phone Number Maximum 20 characters Please enter a phone number.
- Mom's Cell Phone Number Maximum 20 characters Please enter a phone number.
- Primary Email REQUIRED Please fill out this field. Please enter an email address.
- Are you a registered member of Good Shepherd? REQUIRED Yes No Please fill out this field.
- How many high schoolers would you like to register for our H.S. Flock Winter Retreat 2023? REQUIRED Please fill out this field.
  
  Name of High Schooler 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level (as of fall of 2022) REQUIRED Please fill out this field. Please enter an integer (number).
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Name of High Schooler 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level (as of fall of 2022) REQUIRED Please fill out this field. Please enter an integer (number).
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Name of High Schooler 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level (as of fall of 2022) REQUIRED Please fill out this field. Please enter an integer (number).
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Name of High Schooler 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level (as of fall of 2022) REQUIRED Please fill out this field. Please enter an integer (number).
  
  School District REQUIRED Please fill out this field. Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
  
  Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- FAMILY DOCTOR
- What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.
- Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.
- #1 EMERGENCY CONTACT
- List Emergency Contact (other than parents).
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Relationship Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- #2 EMERGENCY CONTACT
- List Emergency Contact (other than parents).
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Relationship Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- ARCHDIOCESE OF CINCINNATI YOUTH
  PERMISSION FORM FOR THE H.S. WINTER 2023 RETREAT
  Retreat Date: January 14 to January 15, 2023
  
  Please download, read and retain the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form ►
- I have read and agree to the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form that has been provided in the block above. REQUIRED Yes No Please fill out this field.
- PHOTO PERMISSION
  I understand that Good Shepherd’s Faith Formation staff may take photos and videos during activities for the purpose of promoting the programs via our website, Sunday bulletin, parish social media page (for example, Facebook, Twitter, Instagram), or news releases to local or diocesan papers. I give my permission for pictures that are taken of my family, adults and children, to be used for this purpose.
- I have read and agree to the Photo Permission statement listed above. REQUIRED Yes No Please fill out this field.
- Please be aware that we will continue to follow the guidelines of the Archdiocese of Cincinnati regarding social distancing and other precautions due to the COVID-19. We appreciate your patience and flexibility in the event changes are needed to be made.
- I have read and understand that we are following all Archdiocesan Guidelines related to the pandemic, and if changes occur with the pandemic we will adjust accordingly. REQUIRED Yes, I have read and agree to the statement above regarding the pandemic. Please fill out this field.
- By clicking on the "I Agree" box, it will serve as your digital signature for this submission.
  I Agree Please select this field.
- If you would like to share any additional information, please do so in the box below.
- Name of Custodial Parent/Legal Guardian REQUIRED Please fill out this field. Please enter valid data.
- Please type your initials below. REQUIRED Please fill out this field. Please enter valid data.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
Submit

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