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RETREAT
Kansasville, WI | November 15-17 | $200
Teen Name
(Required)
First
Last
Is your teen currently registered for Life Teen?
(Required)
Yes
No
Would you like to apply all contact information, emergency contact information and waivers to their retreat registration?
(Required)
Yes
No
Gender
(Required)
Male
Female
High School
(Required)
Grade (2024-2025)
(Required)
9th Grade
10th Grade
11th Grade
12th Grade
Teen Contact Information
Teen Communication: (Cell phone and email communication will only be used by Life Teen Youth Ministers and Core Members to share youth ministry information, for invitations to youth ministry activities and events, and for Life Teen related messages.
Teen Email
(Required)
Teen Phone
Parent/Guardian Contact Information
Parent/ Guardian Name
(Required)
First
Last
Parent/ Guardian Email
(Required)
Parent/ Guardian Phone
(Required)
In Case of Emergency
Emergency Contact Name
(Required)
First
Last
Different from parent/guardian listed above.
Emergency Contact Relationship to Teen
(Required)
Emergency Contact Phone
(Required)
Medical Waiver
(Required)
I agree to the terms and conditions of the medical waiver.
If the parents or guardians cannot be contacted in case of serious injury or illness, I authorize St. James Staff to take emergency action deemed necessary, including the transportation of the student to a hospital or medical center. As a parent or guardian, I authorize the treatment by a qualified and licensed medical doctor of the minor(s) listed in this registration in the event of a medical emergency that, in the opinion of the attending physician, may endanger his/her life, cause disfigurement or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.
Please list any known allergies or medical conditions that would affect your teen's participation during the Life Teen Retreat.
(Required)
Photo/Media Waiver
I agree to the terms and conditions of the photo/media waiver.
I hereby authorize and give my full consent to St. James Parish the use of my child(ren)’s image (photographs, video, and/or audio) and further agree that St. Jams Parish may use these photographs, video or audio files for promotional materials.
Liability Waiver
(Required)
I agree to the terms and conditions of the liability waiver.
I hereby give permission to my son/daughter, mentioned above, to participate in activities sponsored by St. James. I hereby release and indemnify the Archdiocese of Chicago, St. James for this event, its staff and volunteers; and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation in the program. I understand that if my child violates any laws regarding possession of alcohol or drugs, or rules governing the event, I will be called and notified about situation and/or arrangements made to send my child home at my expense.
Payment
Retreat Registration
(Required)
Retreat Registration (Life Teen Teen)
Retreat Registration
(Required)
Retreat Registration
Total
Coupon
Payment Method
(Required)
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
Close Menu
Come to St. James
What to Expect
Mass Times
Path To Sunday
Sacraments
Adoration Chapel
Bulletin
Funeral Planning
Who We Are
About
Staff
Register as a Parishioner
Jobs at St. James
Formation
Adults
Children & Youth
Behold | Learn About Catholicism
Connect
Get Involved
Serve
Liturgical Ministries
Non-Liturgical Ministries
Ministry Directory
Events
Events at St. James
Request a Room / Setup & Marketing Resources
School
Jubilation
Support
Donate
Jubilation
St. James School Tuition Assistance Program
Watch Online
Join us for our Mass livestream
Watch Online