St. Angela Merici Parish ~ 20970 Lorain Road ~ Fairview Park ~ Ohio ~ 44126 ~ 440-333-2133 ~ www.samparish.org
Retreat Reservation Form – Jan. 20 at 7 p.m.-Jan. 22 at 11 a.m.
St. Leonard Youth Retreat Center – 4076 Case Road, Avon, OH
All high school students are invited to expand their understanding of the role that God and faith
play in their lives. Faith, friendship and fun will be ever-present at this retreat.
Name_______________________________________
Phone_____________________
Address____________________________________________________
Email_______________________________________ Shirt size_______
Parent/guardian__________________________________Phone______________________
The cost of the retreat is $80 (checks to St. Angela). Please return payment with form. If you
don’t have a medical form on file with YOSA, I will get you one to return. The cost covers the
cost of food, lodging, supplies and a t-shirt. Financial assistance is available for the retreat. If
you cannot afford to pay, you can pay what you can afford now or later. The student is asked to
write an essay on why they want to go on this retreat in order to receive financial assistance.
Email or call me with any questions ([email protected] or 440-333-2133 ext. 121- Maureen
Adler). More forms are available on parish website under yosa (www.samparish.org)
Please get reservation in by Jan. 8, drop off at parish center or mail to St. Angela (20970 Lorain
Rd., Fairview Pk 44126) . SPACE IS LIMITED. (first come, first serve)
As a parent/guardian of _______________________, I do hereby grant permission to attend the YOSA
retreat. I acknowledge that my child will travel to and from this retreat in transportation provided by St.
Angela parents and team members. I understand my child will leave and return to St. Angela Rini Center.
I agree to release St. Angela Parish, the youth ministry program and all supervisors, organizers and
volunteers associated with the retreat and the Catholic Diocese of Cleveland from all claims and liability
for any injury or medical fees incurred as a result of my child’s participating in this activity.
Name_______________________________________________ Date_________________
Parent help is needed:
_____ I can help driver team members on Friday at 4:30 p.m.. I can take ____ passengers
_____ I can drive to retreat on Friday at 7 p.m.. I can take _____passengers
_____ I can drive from the retreat on Sunday at 11 a.m.. I can take_____ passengers
I can help with a meal:
_____Saturday 11:30 a.m. lunch tray pickup and delivery to retreat
_____Saturday 5 p.m. dinner pick up/clean up and delivery to retreat
*I will help where needed, just call_______________________- questions? (M. Adler 440-503-4300)
Name______________________________________________ phone____________________