This application is for TEC 200 at Conception Abbey February 18-20, 2012
For the Teen Apllication
Click Here
.
Please fill the form out completely and truthfully. To download a paper copy
Click Here
.
Application Deadline is Feb. 1st, 2012
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Required
Personal Information:
First Name
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Last Name
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Nickname (Preferred Name)
Gender
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Birthdate
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Place of Employment (If applicable)
Parish
Contact Information:
Street Address
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City
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State
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Please enter a valid zip code.
Zip Code
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Please enter a valid email address.
Email Address
Please inculde an area code.
Phone Number
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Please inculde an area code.
Work Phone Number (If applicable)
Patron Saint's' Name
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Other Information:
List any involvement you have with parish/community programs.
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Why are you interested in making a TEC weekend?
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Please list anyone who you know that will be on the same weekend.
Who recommended TEC to you?
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Please list any special health conditions (if applicable).
Emergency Contact Person
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Please enter a number.
Phone Number
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Relationship
*
I wish to participate in the TEC weekend and plan to stay the entire weekend at Conception Abbey. I agree to hereby release, indemnify and save harmless Conception Abbey, the Diocese of Kansas City-St. Joseph, the Heartland TEC Board, TEC Conference, and any persons connected with the University or TEC weekend from any and all liability, claims, damages for personal injury, or property loss/damage which may arise as a result of this retreat. I agree not to sue any of the above parties, their representatives, agents, employees, or volunteers.
I give permission for the use of my picture, (individual or group), or written words to be included on the TEC Web site (local or national) for the purpose of displaying pictures/comments in brochures in both print and electronic format for advertising about TEC .
You will also be asked to sign a copy of this statement before beginning the weekend.
