Saint Theresa of the Infant Jesus Parish

New Cumberland, PA
(717) 774-5918

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

EUCHARIST RETREAT PERMISSION

FIRST EUCHARIST RETREAT- MAY 2022

Destination: St. Theresa of the Infant Jesus Church

Designated Supervisor of Activity: Adalene Noll

Date and Time of Event:

STS – Wednesday, May 4, 12:30–2:30 PM
RE – Saturday, May 7, 9:30–11:30 AM

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

Printable Form – First Eucharist

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 PARTICIPATION
- 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 FIRST EUCHARIST 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.
- My child has 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 medical concern, please describe.
- 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.
- 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 retreat.
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Email Please enter an email address.
Submit

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