Kairos Retreat for Teens [SFK13] September 22, 23, 24 & 25 th, 2016

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1 For Juniors & Seniors in High School What is Kairos? Kairos, which means Lord s Time, is a Christian experience of prayer and reflection, run by a team of adults and trained peer leaders. St. Francis de Sales Parish began hosting Kairos retreats for high school juniors and seniors in This retreat was designed for public school teens who did not have the opportunity to experience a Kairos retreat through a Catholic high school. Kairos is a powerful and life-changing opportunity for teens to grow in their knowledge of themselves, others, and especially, God. Kairos is open to any junior or senior high school student who would like to join us. Participants need not be Catholic to be on this retreat. Eight Good Reasons to Encourage your Teen to Participate in a Kairos Retreat 1. Everyone needs time to reflect, especially in our busy world and especially our young people. This retreat offers teens a break from the many distractions in their lives. 2. The Kairos retreat centers on seeing God s love in our lives and introduces young people to developing their own personal spirituality. 3. High school Peer Ministers, are integrally involved in ministering to their peers attending the retreat, as retreat team leaders. They create an open and accepting retreat experience. 4. While on retreat, the retreatants will experience a Catholic Christian faith community. 5. The Kairos retreat serves as a catalyst for forming an on-going community, which offers young people an opportunity to build their relationship with God through the support of their peers and the larger parish community. 6. The retreat introduces young people to faith sharing, scriptural prayer, liturgy and journaling as ways to grow in their faith. 7. Kairos calls young people to continue their journey once back home. 8. Topics to be covered: one s personal identity as a follower of Jesus, spirituality within friendship and family, personal prayer and faith, and God s Love and forgiveness. Application Deadline August 24, 2016 Please submit your application ASAP We will accept late registration forms until the retreat is full. Kairos is offered twice per year. The next Kairos retreat opportunity will be February 2017

2 Why should you go? This is the question you should really be asking yourself! Why should I spend my time reflecting on my life at a retreat? It is hard to know until you have tried. Maybe you are nervous about going off to college. Maybe you are trying to decide if you want to go to college. Maybe you are hurt. Maybe you are healed and wish to rejoice! Maybe you don t know if God really cares. Maybe you need to find out just how much He does. There are so many reasons those who have already gone on Kairos could give you about why you should go. Thousands of teens go on Kairos each year. They go and discover who they really are and how they want to live. They come for their own reason and all leave changed. Maybe the best reason to go is that someone cares enough about you to invite you. Talk to past Kairos participants, youth ministry adults, or a priest and ask them why. Even if you decide not to go, you owe it to yourself to explore why so many people consider that a retreat is essential experience in their lives. Details Kairos Retreat dates are scheduled around the school schedule so no classes will be missed! Spaces are limited so please register early! Cost: $ (non refundable) for 4 days & 3 nights, all meals, transportation & materials. Checks can be made out to St. Francis de Sales Youth Ministry. Please return permission forms and payment to: St Francis de Sales - Youth Ministry 135 S. Buesching Road, Lake Zurich, IL attn: Cathy Chiarelli - Kairos Application Deadline August 24 th, 2016 Please submit your application ASAP We will accept late registration forms until the retreat is full.

3 PLEASE KEEP THIS PAGE FOR YOUR REFERENCE Packing List The retreat center has bedrooms with bed linens, but you may bring a pillow or any other bedding (if you prefer) Casual clothes ( layers can be helpful during this retreat ). Please no inappropriate t-shirts or sweatshirts or shorts. Pajamas Outdoor shoes & jacket Bath towel Toiletries (shampoo, soap, deodorant, toothbrush & paste etc.) Please do not bring: Homework Drugs, alcohol, cigarettes - etc. Are never allowed Please bring snacks to share with the group! We are together and busy for 4 days, and the teens get hungry. They appreciate all snacks, and have plenty of opportunities to grab a snack throughout the weekend. Think about what snacks you enjoy throughout a normal weekend. Food is not allowed in bedrooms. Transportation You will be transported to and from the Retreat Center by bus. Friday - 4:30 pm bus leaves from St. Francis de Sales Ministry Center! Monday - return to St. Francis church. Please do not make plans before 7:30pm.

4 STATEMENT OF PERMISSION & RELEASE OF LIABILITY St. Francis de Sales Parish Publications & Website Dear Parent(s) or Guardian(s): As we maintain our school and parish websites and develop marketing materials, we are looking for photographs of parishioners and students participating in parish- and school-related activities and events. These photographs will be used for the sole purpose of visually enhancing our parish and school websites. Because of student privacy laws, we want to secure parental permission before publishing photographs of any minors enrolled in St. Francis de Sales School, St. Francis de Sales Religious Education or St. Francis de Sales Youth Ministry Programs on our website. We value your family s participation in our parish and school programs and ask for your permission to include images of your child(ren) on our website and in our parish materials. Please fill in the information and sign and date at the bottom: STUDENT S NAME: (PLEASE PRINT) YEAR OF GRADUATION: AGE: PARENT S NAME(S) (WHO YOU LIVE WITH): HOME ADDRESS: CITY, STATE, ZIP CODE: HOME PHONE #: HOME FATHER S PHONE #: FATHER S MOTHER S PHONE #: MOTHER S Permission I understand, as a parent/legal guardian of the above-named child, that I am giving St. Francis de Sales Parish and St. Francis de Sales School permission to use a photograph of my child on the school and parish websites. Any image will be used for the sole purpose of visually enhancing the parish and school websites. The photos will also be used for the St. Francis de Sales Bulletin and on future Kairos Brochures. Yes, I give permission to St. Francis de Sales Parish and St. Francis de Sales School. No, I do not give this permission to St. Francis de Sales Parish and St. Francis de Sales School. Parent/Legal Guardian Signature: Date: If you have any questions or concerns, please contact Diana at or at Thank you!

5 LIFE TEEN - CONFIRMATION PROGRAM PARENTAL PERMISSION & LEGAL RELEASE I give permission for my daughter/son to attend the Kairos Retreat I give permission to my son/daughter (PRINT participant s name) to participate in the event sponsored by St. Francis de Sales Parish. I hereby release and indemnify the Archdiocese of Chicago, St. Francis de Sales Parish for this event, its staff and volunteers; and the Catholic Bishop of Chicago, a Corporation Sole, from any and all liability arising from claims of any kind of nature whatsoever from my child s participation in the program. I understand that if my child violates any laws regarding possession of alcohol or drugs, or rules governing the event, I will be called and notified about the situation and/or arrangements will be made to send my child home. Lastly, I release the Archdiocese of Chicago and St. Francis de Sales Catholic Church (it s staff and volunteers) from any and all responsibility should my son/daughter experience some injury or accident while participating in this event. PARENT/GUARDIAN SIGNATURE TEEN SIGNATURE Yes No St. Francis de Sales Parish may use photographs/videos of my child at this event for promotion in the bulletin/parish website/ parish Facebook Page Teen Signature Parent/Guardian Signature Date Parent Contact Information NAME CELLPHONE NAME CELLPHONE HOME PHONE Medical Authorizations In the event that the undersigned cannot be reached, and in the judgment of the responsible adults or other appropriate staff members accompanying the group. If there is a necessity from immediate examination and/or treatment of my child. I hereby authorize any of the aforesaid personnel to obtain for my child such medical services as are deemed necessary. Emergency Contact (In the event that parent(s)/guardian(s) cannot be reached.) NAME OF EMERGENCY CONTACT RELATIONSHIP PHONE # NAME OF PHYSICIAN PHONE # ADDRESS CITY, STATE ZIPCODE Insurance Information POLICY IN THE NAME OF: POLICY # INSURANCE COMPANY ID # Health Information ALLERGIES: CURRENT MED/S OTHER COMMENTS:

6 MEDICAL AUTHORIZATION FORM for St. Francis de Sales, 135 S Buesching Road Lake Zurich, IL Student Name: Date of Birth: Grade: Date: (Last, First, Middle) Medications may be administered during this event, as authorized on the Physician s Order form. NO medication may be administered during this event unless both the student s physician and parent/guardian have completed, signed, and returned this entire form to St. Francis de Sales, Youth Ministry department prior to leaving this event, and the Medication in the original labeled container as dispensed (prescription medication) or the manufacturer s labeled container (non-prescription medication). The medication label shall contain the student s name, name of the medication, direction for use and date. PARENT/GUARDIAN PERMISSION AND AUTHORIZATION I hereby acknowledge that I am primarily responsible for administering medication to my child. However, in the event that I am unable to do so or in the event of a medical emergency, I hereby authorize the Youth Ministry Retreat Leader or his/her designee, on my behalf to administer or to attempt to administer to my child (or allow my child to self-administer, lawfully prescribed medication and nonmedication in the manner described in the Physician s Order (Reverse Side). I acknowledge that it may be necessary for the administration of medications to my child to be performed by an individual who does not have medical training, and I specifically consent to such practices. I understand that this authorization is not effective unless the Youth Ministry Retreat Leader or his/her designee has approved the medication authorization for my child and signed this form in the space provided below. I further acknowledge and agree that, when such medication is to be administered or attempted to be administered, I waive any claims I might have against St. Francis de Sales parish, Youth Ministry Retreat Leader Volunteers, the Catholic Bishop of Chicago, or any of their employees or agents arising out of the administration or attempted administration. In addition, I agree to hold harmless and indemnify St. Francis de Sales parish, Youth Ministry Retreat Leader Volunteers, the Catholic Bishop of Chicago, and their employees or agents, jointly or severally, from and against any and all claims, damages, causes of action or injuries incurred or resulting from this administration or attempted administration of said medication PARENT/GUARDIAN (PRINT) PARENT/GUARDIAN (PRINT) PARENT/GUARDIAN (SIGNATURE) PARENT/GUARDIAN (SIGNATURE) ADDRESS ADDRESS CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE HOME PHONE HOME PHONE CELL PHONE CELL PHONE Archdiocese of Chicago Office of Catholic Schools June 2008 MEDICAL AUTHORIZATION FORM PARENT/GUARDIAN COPY PAGE 1 OF 2

7 TO BE UPDATED BY PARENT/GUARDIAN/PHYSICIAN ANNUALLY PHYSICIAN S ORDER Student s Name Grade MEDICATION/HEALTH CARE TREATMENT DOSAGE TIME(S) TO BE ADMINISTERED INTENDED EFFECT OF THIS MEDICATION EXP ECTED SIDE EFFECTS, IF ANY OTHER MEDICATIONS THE STUDENT IS TAKING (PLEASE CIRCLE) May student self-administer medication under supervision of Youth Ministry Leader who does not have medical training? YES NO FOR ASTHMA AND ALLERGY CONDITIONS ONLY: I certify that this student has been instructed in the use and self-administration of this medication and is capable of self-administering this medication independently and without supervision. YES NO I also request that this student be allowed to carry the above-described medication on their person during the Retreat in order to facilitate the self-administration of the medication as needed. YES NO ADMINISTRATION INSTRUCTIONS: Physician s/prescriber s Signature Date Signed Physician s/prescriber s Name (PRINT) Emergency phone number Physician s Address City, State, Zip Code Medication Authorization approved or denied and signed this day of BY: Signature of Youth Minister or Youth Ministry Volunteer on behalf of St. Francis de Sales Parish, 135 S Buesching Road Lake Zurich, IL Archdiocese of Chicago Office of Catholic Schools June 2008 MEDICAL AUTHORIZATION FORM PARENT/GURADIAN COPY PAGE 2 OF 2

8 Clarification of necessary permission / medical forms for retreat Permission Form All teens must submit the Permission & Legal Release Form with emergency contact information etc. to attend this event. Medical Forms If your teen will not be bringing any medications on the retreat then the medical authorization form does not need to be returned. If your teen is bringing either PRESCRIPTION MEDICATIONS (Antibiotics, asthma/allergy medications, stomach medications, etc.) or OVER THE COUNTER MEDICATIONS (Tylenol, Ibuprofen, Advil, tums, etc.) The medical authorization form must be completed and signed by you and by your teen s doctor. Any questions about requirements for the Medical forms please contact Cathy Chiarelli

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