Saint Theresa of the Infant Jesus Parish

New Cumberland, PA
(717) 774-5918

Confirmation Retreat Permission

- Parish Life
  - Get Involved
    
    Adoration Chapel
    Bingo
    Smart Money / Gift Card Program
    That Man is You
    She Shall Be Called Woman
    Men's Retreat
  - Youth
    
    Altar Servers
    Boy Scouts / Cub Scouts
    REVIVE Youth Group
    Religious Education
    
    Parish RE Preschool
    Parish RE Grades 1 -8
    Make a Payment
    Confirmation Retreat Permission
    
    Eucharist Retreat Permission
    
    St. Theresa School
  - Outreach
    
    Healing Mass
    Sister Parish
  - Church Groups
    
    Chaplet of Divine Mercy
    Council of Catholic Women
    Little Flower Club

Destination: St. Theresa of the Infant Jesus Church

Designated Supervisor of Activity: Adalene Noll

Date and Time of Event: Thursday February 24, 2022 8:30 AM - 2:30 PM

Click this link to print the permission form. Please complete and mail it or deliver the form to the parish office.

OR

Complete the online form below and submit electronically:
The maximum number of form submissions has been reached. This form is currently not available.
- PARENT PERMISSION AND WAIVER FORM FOR FIELD TRIP PARTICIPATON
- Dear Parent or Legal Guardian:
  
  Your son/daughter is scheduled to participate in a parish-sponsored activity. This activity will take place under the guidance and supervision of Mrs. Adalene Noll, Coordinator of Parish Religious Formation at Saint Theresa Parish.
- Name of CHILD attending CONFIRMATION Retreat
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- CONSENT AND WAIVER
  I hereby request participation of my child in the event described above. I understand that it will take place on the parish grounds and that my child will be under the supervision of the designated parish employee/volunteer on the stated dates.
  
  I hereby agree, on behalf of the named student and his/her other parent or legal guardians, to waive any claims for liability against this parish, the Diocese of Harrisburg (and any diocesan or parish officers, agents, or employees) which may arise from the participation of the named student in the above-described event.
- Does your child have any special medical concerns REQUIRED YES NO Please fill out this field.
- My child has food allergies REQUIRED YES NO Please fill out this field.
- If YES to either, please describe:
- By typing your name below, you understand that you are electronically signing this document and are agreeing to all the policies, terms, and conditions set forth above.
  
  Parent's Name
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
- Phone Number where you can be reached during the event REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Additional Phone Number Maximum 20 characters Please enter a phone number.
- I have diocesan youth protection clearances and can help on the day of the event
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Email Please enter an email address.
Submit

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