St. Clare of Assisi Catholic Church
3131 El Dorado Blvd, Houston, TX 77059
(281) 286-7729

PLEASE NOTE: We will never solicit money or gift cards for staff or clergy via email or text. Please notify the Parish Office of any suspicious communications.

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Chosen Confirmation Retreat

- Faith Formation

The date of the 2023 St. Clare of Assisi Confirmation retreat "Chosen" is March 4, 2023. This is an all-day retreat hosted at St. Clare's starting at 9 am and concluding at 6:00 pm following the Saturday 4:30 Vigil Mass. Check-out from the retreat is after the Mass. As this is only an one day Confirmation retreat, you must be there the entire time in order to receive credit.

Please note that this retreat is only for Year 2 Confirmation candidates.

The form below along with the $65 registration fee (cash or check made out to St. Clare of Assisi) is due to the St. Clare Parish Office by Feb. 6, 2023 in order to order all materials and shirts in time. Breakfast, lunch & a t-shirt will be provided. A t-shirt is not guaranteed for any late registrations.

If you have any questions, please email Youth Director Elizabeth Selmarten, [email protected]
Chosen Retreat Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- Please fill out the registration form below if you are wanting to sign up for the 2023 Chosen Confirmation Retreat.
- Personal Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- Address Line 2 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Current Grade Level or Position REQUIRED Please fill out this field.
- Adult T-Shirt Size REQUIRED Please fill out this field.
- PARTICIPANT: In signing the line below I agree to abide by any/all policies and rules established for this event. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent’s expense.
- Electronic Signature of Participant REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Email Please enter an email address.
- Phone Number Maximum 20 characters Please enter a phone number.
- Emergency Contact Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Insurance & Medical Information
  
  Personnel will take reasonable care to see that the following information will be held in confidence.
- Name of Doctor REQUIRED Please fill out this field. Please enter valid data.
- Doctor Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Medical Conditions/Special Needs REQUIRED Please fill out this field.
- Allergies/Special Notes REQUIRED Please fill out this field.
- Medications
  Please list all medications your child is currently taking. Your child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows:
- Do you/your child have medical insurance coverage at this time? REQUIRED Please fill out this field.
- Insurance Carrier Please enter valid data.
- Name of Insured Please enter valid data.
- Insurance ID Please enter valid data.
- Insurance Group Number Please enter valid data.
- Consent & Liability Waivers
- Consent and Liability Waiver
  I grant my permission for me/my child(ren) to participate in the Chosen Retreat. In the event of any accident or injury, I agree on behalf of myself, my child(ren)'s other parent if known or living, the child(ren) named above or our heirs, successors and assigns, to hold harmless and defend the Archdiocese of Galveston-Houston, St. Clare of Assisi Catholic Church (its pastor and other agents etc.) or any other representatives associated with the scheduled activity, unless the parties involved were careless.
  I Agree Please select this field.
- Medical Waiver
  I hereby warrant to the best of my knowledge, me/my child(ren) is/are in good health, and I assume all responsibility for the health of my child. In case of an emergency and I cannot be reached, please contact the emergency contact listed above. In the event of an emergency, I hereby give permission to the staff of St. Clare of Assisi Catholic Church to seek emergency medical transport and/or treatment for my child(ren) named above. I will be responsible for all costs incurred. I wish to be advised before further care is given by the hospital or doctor.
  I Agree Please select this field.
- Video & Photography Consent
  As a parent/guardian, I understand that promotional pictures and videos (individual and group) may be taken during the Chosen Retreat. I give permission for me/my child(ren)'s pictures (named above) to be used for church promotional materials such as newsletters, web pages, social media, calendars, Power Point presentations, or videos to promote or highlight activities of the children participating in Chosen Retreat.
  I Agree Please select this field.
- Electronic Signature REQUIRED Please fill out this field. Please enter valid data.
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Chosen Confirmation Retreat

Personal Information

Parent/Guardian Information

Emergency Contact Information

Insurance & Medical Information

Consent & Liability Waivers