RETREAT TEAM- 9th Grade Retreat (Jan 25)

DATE: Sunday, January 25

Please arrive no later than 9:00 a.m. - Zore Hall *school gym

We will attend 11:30 a.m. Mass during the retreat

Retreat will officially be held from 10:00 a.m.- 4:30 p.m. but we will need team to plan to stay until 5:00 p.m. to clean up.

**Light breakfast, Lunch & snacks provided

REGISTRATION DEADLINE:
Sunday, Jan. 11 (t-shirts will be provided to those who register and pay by this date)

COST: $25
Please register online and turn in a check (written to St. Susanna) or cash to Ellice Bedel.

Name Name First Last
Role

Role Adult Leader 10th Grade HS Leader 11th Grade HS Leader 12th Grade HS Leader
Gender
T-shirt Size (included with registration fee)
Team Member Email
Team Member Cell Phone Team Member Cell Phone - ### - ### ####
Parent Name (or Emergency Contact if you're an adult) Parent Name (or Emergency Contact if you're an adult) First Last
Parent/Emergency Contact Phone Number Parent/Emergency Contact Phone Number - ### - ### ####
Allergies, Medical Condition, Dietary Needs, or any other Special Needs:
**Put 'NA' if it is Non-Applicable
LIABILITY WAIVER
Please sign below to indicate you have read and agree to the terms of the following Liability Waiver:

I grant my son/daughter permission to participate in the 9th Grade Retreat on January 25, 2026.

In consideration of the opportunity for my child to participate and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental in such participation and do hereby release, absolve, indemnify, and agree to hold harmless St. Susanna Parish, the Archdiocese of Indianapolis, its agents, employees and offices and the chaperones, leaders, organizers and sponsors, and persons. Neither the Archdiocese of Indianapolis/St. Susanna Parish nor any of said persons shall be held financially responsible for any injury, illness, or death incurred as a direct or indirect result of the activity. 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 permission to transport my child to a hospital for emergency medical treatment to be administered. I wish to be advised prior to any further treatment by the hospital or doctor.
We, the undersigned, have read this release and understand all its terms and execute it voluntarily and with full knowledge of the significance.
(Parent, draw your signature into the box below)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.