Chicago Family Synaxis Lenten Retreat 2020 Registration Form

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Thank you for registering for the 2020 Family Synaxis Lenten Retreat!

Simply fill out this form and click "Submit." YOU WILL BE FULLY REGISTERED ONCE YOUR PAYMENT HAS BEEN RECEIVED.

PAYMENT OPTIONS:
Check:
Make your check out to "Metropolis of Chicago" with "Family Synaxis Lenten Retreat 2020" in the memo, and mail to:
Greek Orthodox Metropolis of Chicago
Family Synaxis Lenten Retreat
555 E. Butterfield Rd, Ste 201
Lombard, IL 60148

Credit Card:
You may also pay online through PayPal. The PayPal button can be found on the Family Synaxis home page right next to the registration button.

ALMSGIVING OPPORTUNITY: As a group, we will work on a philanthropy project during the retreat. Please consider making a donation towards the cost of supplies for the project when you make your payment. (There is a drop-down menu that gives you an option of a $10 or $25 donation for those paying online.)

Thank you!

Is this your first Family Synaxis Retreat?

Yes

Clear selection

What is your family's last name? *

What is the wife's name?

What is the husband's name?

What is your home address?

Include street number, city, state, zip code

What is your phone number (the best number on which to reach you)? *

Please include area code

Please list the cell phone numbers we can reach you at in case of an emergency during the retreat *

Label them if you include more than one

What is your email address? *

Label them if you include more than one (And of course we promise not to sell your contact information!)

What is your home parish?

Please include the jurisdiction (eg Greek, Russian) and city

How many years have you been married?

Please list your youngest child's name (LAST, first), grade, and age.

ie Poulos, James, pre-K, 4 y.o. (leave blank if not applicable)

Please list your 2nd youngest child's name (LAST, first), grade, and age.

ie Poulos, Maria, 1st grade, 6 (leave blank if not applicable)

Please list child 3's name (LAST, first), grade, and age.

ie Poulos, Mark, Senior, 17 (leave blank if not applicable)

Please list child 4's name (LAST, first),grade, and age.

(leave blank if not applicable)

Please list child 5's name (LAST, first), grade, and age.

(leave blank if not applicable)

Please list child 6's name (LAST, first), grade, and age.

(leave blank if not applicable) ** If there are additional children, include in comments box at end of form)

Please check off which members of your family will be attending the retreat *

Husband

Wife

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Required

Do you have a child with a special need who will be participating in the Pick Up Your Cross portion of the retreat? Please provide some details about your child's special need and the necessary supports and accommodations below.

You will be contacted by Presvytera Toni Mihalopoulos, Director of Pick Up Your Cross and Follow Me, our Metropolis' Ministry for those with special needs, to see how we can best support your child the day of the retreat.

So that we may pray for each member of your immediate family during worship services, please list their BAPTISMAL names.

So that we may commemorate their names, please list the BAPTISMAL names of any deceased members of your immediate family.

Does anybody in your family have an allergy or medical condition we should be aware of? Please provide the information below *

write "no" if none

Use this space for additional comments or questions

ACCEPTANCE OF RESPONSIBILITY *

In order for the family members identified on this registration to attend the Metropolis of Chicago Family Synaxis 2020 Lenten Retreat at St. Athanasios Greek Orthodox Church, I agree to the following: 1. To supervise my child or children during all times other than during scheduled class time (during which I agree to teacher supervision, unless I am asked to remove my child or children from class); 2. To accept responsibility for any and all damage caused in whole or in part by my child or children, whether intentional or unintentional, and to reimburse the host church for repair or replacement of the damaged property; 3. To discuss with my child or children, prior to the retreat, their obligation to behave appropriately in all areas of the church building (inappropriate behavior includes but is not limited to yelling, vandalism, running, entry into restricted places, climbing, creating a mess, and pulling pranks); and 4. To secure each family member’s signature on an acknowledgment at check-in consistent with this Acceptance of Responsibility.

I have read the above Acceptance of Responsibility and agree to the terms.

Required

Thank you!

Look for a confirmation email from Chicago.Family.Synaxis@gmail.com in the next few days. If you do not receive one, then please contact Evelyn Maggos at 847-791-5644.

Don't forget to go back to Family Synaxis website to click on the "donate" button and make your registration payment. You may also send a check to the Metropolis of Chicago.

Your registration will be completed once payment is made via PayPal or check postmarked by deadline date.

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