Register for the Emmaus Youth Retreat

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Pastor: Rev. Jason R. Signalness
Phone: 1-701-628-3405
E-mail: [email protected]

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Emmaus Youth Retreat - Sun., Dec. 10th, 2023
- The Bismarck Diocese has partnered with University of Mary to bring a team of college students on fire to evangelize, to your area and offer a deep Eucharistic Retreat experience. The mission of these retreats is to provide a space where young people can experience the love of God in a renewed and transformative way. The title Emmaus is derived from chapter 24 of Luke's gospel— where Jesus draws near to His discouraged disciples. Jesus' model of evangelization in this gospel account is one we seek to follow through these retreats.
  
  The Emmaus Youth retreats are lead by the University of Mary Ministry team and the Bismarck Diocese. The retreats will feature talks, activities, music, Eucharistic Adoration, Mass, and fellowship with other young Catholics. The retreat is open to youth grades 6-9, and to all students preparing to receive the sacrament of Confirmation.
  
  Our confirmation students are expected to attend this retreat.
  
  It is on Sunday, December 10th, 2023, at St. Joseph Church in Williston.
  
  We will leave Stanley about 10:40 a.m. and return about 7:30 p.m. that day.
  
  To sign up, a parent or guardian must complete the form below prior to the event. Paper forms are available in the parishes.
Parental/Guardian Consent Form and Liability Waiver
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Student 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.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Home Address REQUIRED Please fill out this field. 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.
  
  Parent or 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.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  I grant permission for my child (named above) to participate in the Emmaus Retreat at St. Joseph Church in Williston, ND, on December 10th, 2023.
  
  As the parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor ("participant"). I agree on behalf of myself, my child, or our heirs, successors, and assigns, to hold harmless and defend Queen of the Most Holy Rosary and Saint Ann parishes, their officers, directors, employees, and agents and the Diocese of Bismarck, its employees, agents, and chaperones, or representative associated with the event for reasonable attorney's fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parishes/diocese.
  
  Check the box to agree: REQUIRED I agree to the above. Please fill out this field.
  
  Additional Permissions
  
  Photo/Video Consent
  Do you, the parent/guardian(s) of this youth authorize and give full consent, without limitation or reservation, to publish any photograph or video in which the above named student appears while participating in any program associated with the above-named parish/diocese ministry activity? There will be no compensation for use of any photograph or video at the time of publication or in the future.
  
  Photo REQUIRED I consent. I do not consent. Please fill out this field.
  
  Medical Information
  In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment.
  
  Consent for Medical Treatment REQUIRED Yes No Please fill out this field.
  
  I grant permission for non-prescription medication to be given to my child, if deemed appropriate (non-aspirin products such as acetaminophen, ibuprophen, throat lozenges, cough syrup).
  
  Non-prescription medications I consent. I do not consent.
  
  Allergies, Dietary Restrictions, and Prescription Medications
  Please list any allergies, dietary restrictions, and prescription medications for this child. List name and dosage of any medications. The child must bring all such medications as necessary, and they must be well-labeled.
  
  Allergies Medications and Dietary Information
  
  In case of emergency, if you cannot reach the above-named parent/guardian, please contact the following.
  
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  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
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