Confirmation Retreats 2025

This online permission form is for Confirmation Retreats on either...

Sunday, January 26, 2025

OR

Saturday, February 8, 2025

Both retreats will take place from 10:00 a.m. to 4:00 p.m. at the Jesuit Spiritual Center in Milford, OH (5361 S. Milford Rd., Milford, OH 45150).

Please complete the form below. Thank you!

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's Name Please enter valid data.

Mother's Name Please enter valid data.

Street 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.

Home Phone Number Please enter a phone number.

Dad's Cell Phone Number Please enter a phone number.

Mom's Cell Phone Number Please enter a phone number.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Are you a registered member of Good Shepherd? REQUIRED Yes No Please fill out this field.

How many Confirmation Candidates would you like to register for our Confirmation Retreat? REQUIRED Please fill out this field.
Name of Confirmation Candidate 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Level (as of fall of 2024) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- I will be attending the Confirmation Retreat on (please select one option below): REQUIRED Sat., Jan. 26, 2025 (10 a.m.-4 p.m.) Sat., Feb. 8, 2025 (10 a.m.-4 p.m.) Please fill out this field.
- Are you able to attend the Confirmation Mass on April 5, 2025 at 1:30 p.m.? Please note that candidates are expected to attend unless there is a special and unavoidable circumstance REQUIRED Yes, I am able to attend. *No, I need assistance finding another Confirmation Mass. Please fill out this field.
- *Grace Curtis will be in touch with you soon.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Confirmation Candidate 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Level (as of fall of 2024) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- I will be attending the Confirmation Retreat on (please select one option below): REQUIRED Sat., Jan. 26, 2025 (10 a.m.-4 p.m.) Sat., Feb. 8, 2025 (10 a.m.-4 p.m.) Please fill out this field.
- Are you able to attend the Confirmation Mass on April 5, 2025 at 1:30 p.m.? Please note that candidates are expected to attend unless there is a special and unavoidable circumstance REQUIRED Yes, I am able to attend. *No, I need assistance finding another Confirmation Mass. Please fill out this field.
- *Grace Curtis will be in touch with you soon.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Confirmation Candidate 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Level (as of fall of 2024) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- I will be attending the Confirmation Retreat on (please select one option below): REQUIRED Sat., Jan. 26, 2025 (10 a.m.-4 p.m.) Sat., Feb. 8, 2025 (10 a.m.-4 p.m.) Please fill out this field.
- Are you able to attend the Confirmation Mass on April 5, 2025 at 1:30 p.m.? Please note that candidates are expected to attend unless there is a special and unavoidable circumstance REQUIRED Yes, I am able to attend. *No, I need assistance finding another Confirmation Mass. Please fill out this field.
- *Grace Curtis will be in touch with you soon.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.
Name of Confirmation Candidate 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Level (as of fall of 2024) REQUIRED Please fill out this field. Please enter an integer (number).
- School District REQUIRED Please fill out this field. Please enter valid data.
- Sex
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- I will be attending the Confirmation Retreat on (please select one option below): REQUIRED Sat., Jan. 26, 2025 (10 a.m.-4 p.m.) Sat., Feb. 8, 2025 (10 a.m.-4 p.m.) Please fill out this field.
- Are you able to attend the Confirmation Mass on April 5, 2025 at 1:30 p.m.? Please note that candidates are expected to attend unless there is a special and unavoidable circumstance REQUIRED Yes, I am able to attend. *No, I need assistance finding another Confirmation Mass. Please fill out this field.
- *Grace Curtis will be in touch with you soon.
- Please list allergies (e.g. food, drugs, anesthetics). If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list medications taken regularly. If this does not apply, please write "NA." REQUIRED Please fill out this field.
- Please list any conditions/impairments (e.g. epilepsy, diabetes, asthma). If this does not apply, please write "NA." REQUIRED Please fill out this field.

FAMILY DOCTOR

What is the name of your family doctor? REQUIRED Please fill out this field. Please enter valid data.

Phone number for your family doctor. REQUIRED Please fill out this field. Please enter valid data.

#1 EMERGENCY CONTACT

List Emergency Contact (other than parents).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

#2 EMERGENCY CONTACT

List Emergency Contact (other than parents).

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship Please enter valid data.

Phone Number Please enter a phone number.

ARCHDIOCESE OF CINCINNATI YOUTH
PERMISSION FORM FOR THE CONFIRMATION 2025 RETREAT FOR WHICH I REGISTERED.

Please download, read and retain the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form ►

I have read and agree to the Archdiocese of Cincinnati Permission, Release and Authorization to Seek Medical Treatment form that has been provided in the block above. REQUIRED Yes No Please fill out this field.

PHOTO PERMISSION
I understand that Good Shepherd’s Faith Formation staff may take photos and videos during activities for the purpose of promoting the programs via our website, Sunday bulletin, parish social media page (for example, Facebook, Twitter, Instagram), or news releases to local or diocesan papers. I give my permission for pictures that are taken of my family, adults and children, to be used for this purpose.

I have read and agree to the Photo Permission statement listed above. REQUIRED Yes No Please fill out this field.

By clicking on the "I Agree" box, it will serve as your digital signature for this submission.

I Agree Please select this field.

If you would like to share any additional information, please do so in the box below.

Name of Custodial Parent/Legal Guardian REQUIRED Please fill out this field. Please enter valid data.

Please type your initials below. REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter a date.

Confirmation Retreats 2025

Staff Contact

Confirmation Retreat Permission Form 2025