January 6th Retreat Registration

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Retreat Date & Time: January 6th, 2023 // 9am - 4:00pm (NO Mass included)

Retreat Address: St. Bernard's School of Theology & Ministry - 120 French Rd, Rochester, NY 14618

Retreat Theme: Beloved: Our Identity in Christ

Contact/Questions

Tyler Davis at (585) 698-8356 or tyler.davis@dor.org

Luke Nolan at (585) 500-5616 or luke.nolan@dor.org

Candidate Full Name *

Year in Confirmation *

Year 1

Year 2

Parish Affiliated With *

Southeast Rochester Catholic Community (Blessed Sacrament, St. Boniface, St. Mary's)

Peace of Christ Parish (St. Ambrose, St. James, St. John the Evangelist)

St. Leo the Great (Hilton)

St. Stanislaus Kostka

Other:

Candidate Date of Birth *

YYYY

School Attending *

Parent/Guardian Email *

Parent/Guardian Phone Number *

Emergency Contact Name (if different than Parent/Guardian listed)

Emergency Contact Phone Number (if different than Parent/Guardian listed)

Physician Name *

Physician Office Phone Number *

Will your teen be leaving early or arriving late for any reason? *

Yes

Other:

Dietary restrictions *

None

Vegetarian

Vegan

Kosher

Gluten-free

Peanut Allergy

Other:

I understand that photos and videos will be taken at this event for parish promotion/faith formation programming, and my child may be included in these photos. I understand that any photos taken will NOT include my child's surname. *

Yes

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