Middle School Retreat “This is Your Life”

St. Francis Mission in collaboration with St. Charles Borromeo Parish is hosting a retreat for youth 6th-8th grade. The retreat will be held at the Icimani Recovery Center Sunday, July 15 through Tuesday, July 17. The cost is $20 to attend, which will cover the cost of meals and snacks throughout the retreat. Scholarships for discounted cost (worth $10) are available for participants who submit an essay of 250 words or more explaining why they want to participate in this retreat. Essays should be turned in with permission form and money at the St. Francis Mission Administration building, c/o Davanne Piccini. Scholarship winners will be announced in the St. Charles bulletin on July 15th and will be refunded $10 when they sign in for the retreat. Retreatants should bring:

Pillows Change of clothes (3 days) Sleeping bag and blankets Sleepwear Toiletries Swimsuit A snack or beverage to share

------------------------------------------------------------------------------------------------------------ Name of Retreatant ______________________________________________________Grade __________ Allergies (List all) __________________________________________________________________________ _________________________________________________________________________________________________

Any medications that we should be aware of? (Circle one) Yes / No If yes, what medications is your child taking? _____________________________________________ Emergency Contact Information Parent/Guardian Name ___________________________________________________________________ Parent/Guardian Home Phone __________________________________________________________ Cell Phone __________________________________ Work Phone ________________________________

By signing this form, you acknowledge that your son or daughter will be on the St. Francis Mission grounds from July 15-17. You also release SFM and its affiliate programs of any accidents or injuries

that your child may sustain in the course of the retreat.

Parent/Guardian Signature_______________________________________________Date__________