St. Simon the Apostle
LUKE 18
TEAM APPLICATION FORM
JANUARY 9-11, 2015
DUE BY MONDAY, SEPTEMBER 28, 2014
To be a member of St. Simon’s LUKE 18 team involves commitment:
1.
You must be willing to attend weekly meetings (Sundays 1-3pm—November 23, November 30, December 7,
December 14 (No MTG due to finals), December 21, December 28, January 4 9am-6pm for the daylong
meeting/reflection (You can only miss 1 meeting before being dropped from the team)
2.
If you are giving a talk on the retreat you must type it out and email it to Susie by Friday, January 2
Sue021183@yahoo.com
3.
You must be a practicing Catholic (if non-Catholic, support the teaching of the Roman Catholic Church).
4.
You must follow the direction of the Married Couple/Youth Minister(s) and Young Adult Leaders.
5.
You must meet the requirements for the position as suggested by the Luke 18 manual.
NOTE: The cost for a team member is $40 per person. This is essential. This money is necessary to help cover the
costs of putting on a LUKE 18 Retreat.
I agree and commit myself to all the above conditions.
Signature
Date
You would like to participate as:
Young Adult Leader (YADL)
Disciple
Cori Team
Amount Enclosed
Young Adult Support Team (YAST)
Cori Team Leader
NAME:
BIRTH DATE:
ADDRESS:
HOME PHONE: (
t-shirt size
City:
)
State:
CELL PHONE: (
MM/DD/YY
Zip code:
)
YOUR EMAIL ADDRESS:
SCHOOL/OCCUPATION:
HAVE YOU BEEN ON A LUKE 18 BEFORE OR TEC/KAIROS?
Y
N
Y
N
WHAT POSITION (S):
HAVE YOU GIVEN A TALK ON ANY OTHER RETREAT?
WHICH ONE?
WHAT QUALITIES DO YOU THINK YOU HAVE THAT WOULD MAKE YOU A GOOD FIT FOR THIS TEAM?
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WRITE A BRIEF PARAGRAPH ABOUT WHERE YOU ARE RIGHT NOW ON YOUR FAITH JOURNEY.
(Ex. What does your relationship with God look like? How do you pray? How often do you pray?)
__________________________________________________________________________________________________
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I authorize my son/daughter to participate on the LUKE 18 retreat weekend at St. Simon the Apostle Church,
January 9-11, I understand that transportation will be provided by the another team member, sleep house host or
self during this weekend. (MUST BE SIGNED IF UNDER 18 YEARS OF AGE.). I hereby give permission to
the Archdiocese of St. Louis/St. Simon to use any photographs or video footage taken of me in print and on
their website for promotional purposes.
Does the team member have any unusual diet requirements, medical history, medication, or severe allergies? If
so please specify below:
List medications your child is currently taking (Prescription medication MUST have current pharmacy label
with name of child, medicine, correct dose and time and doctor’s name.) Please send enough medicine to cover
doses for this weekend only.
Medication:
Dose:
Time:
Medication:
Dose:
Time:
I want my child
doctor’s orders:
YES
to be responsible for taking his/her medication according to their
NO
If prefer, and authorize the married couples, Susie and Aaron Pollard or Mary and Jerry Willick, to give my
child their medication as prescribed: YES
NO
PARENT’S SIGNATURE:
(MUST BE SIGNED IF UNDER 18 YEARS OF AGE.)
YOUR PARENTS’ EMAIL ADDRESS (if under 18 years of age):
DATE: