2025-2026 Corazón Retreat DATE CONFIRMATION Form

Corazón Retreat Date Confirmation Form

Parent/Guardian Consent Form
Full-Day Sophomore Retreat

This form confirms the date assigned to you by Carondelet High School Campus Ministry for the Corazon retreat.

Location: Fern Cottage in El Sobrante, CA (Corazón 1 & 2) San Damiano Retreat Center in Danville, CA (Corazon 3 & 4)
This form is for families who missed the initial retreat registration window and want to REQUEST to be added to a retreat.

Please understand this does not guarantee you placement on the retreat. If the retreat you are requesting is full, you will be placed on a waitlist.

Campus Ministry will contact you regarding the status of your request. Requests are reviewed on a first-come-first-served basis.
Student First Name
Student Last Name
Student Carondelet Email
Student's Date of Birth

MonthDayYear
Date
I would like to...

Date Confirmation

Please take some time to read this carefully before signing and committing
I am CONFIRMING the following Kairos date which I've been assigned:
By confirming my assigned date for the retreat and signing below, I understand that a request to change my retreat date after the Retreat Date Change Period ends will incur a $75 fee. The deadlines for Retreat Date Change Periods are as follows:
- Corazón 1 & 2: August 13, 2025
- Corazón 3 & 4: December 5, 2025
I also agree to the following Late Cancellation and No-Show Policy:
- A $200 Late Cancellation Fee will apply for any cancellations made within four weeks of the retreat date, except in cases of illness or injury with medical documentation.
- If students do not show up on the day of a retreat without prior cancellation notice, the family will also be charged the $200 Fee.
- Registrations are non-transferable and cannot be given to another student.
Date Confirmation: Parent Signature

Clear
Date Confirmation: Student Signature

Clear

Date Change Request

Please take some time to read through this entire page before requesting the change.
Submitting a change request forfeits my current assigned spot.
Please select your ORIGINAL date:
I would like to switch to:
Please provide a reason for your date change request:
This information is required in order to prioritize any date changes. Please be as specific as possible.

Date Change Request

$75.00 Quantity

Total

Date Forfeit

Please take some time to read through this entire page before forfeiting your date.
Please select the date you are forfeiting:
(Optional) Please provide a reason for your date forfeiture:
I understand the following:
- I am forfeiting my currently assigned spot and will not be reassigned a new date.
- If in the future, I decide to participate in the Corazón retreat, I must email Mr. Grand-Lejano (rlejano@carondeleths.org) to request a new date (pending availability).
By signing below, I acknowledge and agree to the terms and conditions outlined in this agreement.
Assigned Date Forfeit: Parent Signature

Clear
Assigned Date Forfeit: Student Signature

Clear

Late Date Request

Please take some time to read through this entire page before requesting your date.
By selecting "I Agree" below, I acknowledge that I am not currently CONFIRMED or WAITLISTED on any retreat.
Please select the date you are forfeiting:
I understand the following:
- I am REQUESTING a date, but I am not GUARANTEED placement on the retreat roster.
- If the retreat I am requesting is full, I will be placed on a waitlist.
- Campus Ministry will contact me regarding the status of your request.
- Requests are reviewed on a first-come-first-served basis.
By signing below, I acknowledge and agree to the terms and conditions outlined in this agreement.
Late Date Request: Parent Signature

Clear
Late Date Request: Student Signature

Clear

Emergency Information

We are initially gathering this information to streamline the Permission and Consent Form process, which usually occurs one month prior to the retreat date. You will have the opportunity to update or provide new information if any changes arise.
Parent/Guardian 1

First NameLast Name
Phone Number

Area CodePhone Number
Phone Number - Alternate

Area CodePhone Number
Email
Address

Street Address

Street Address Line 2

City

Zip Code
Parent/Guardian 2

First NameLast Name
Phone Number

Area CodePhone Number
Phone Number - Alternate

Area CodePhone Number
Email
Medical

Indicate your student's health considerations and some medical information below.
Carondelet staff can administer over-the-counter medications to my student if needed, including but not limited to: ibuprofen, acetaminophen, benadryl, hydrocortisone, and others).
Dietary Requests (Fill in "Vegetarian", "Vegan", "Celiac-Gluten Free" or leave blank)
Other Health considerations (limited physical activity, social/emotional health, allergies, etc.)
Epipen?
Medications and dosage (students may handle their own medications, as long as it is listed here)
Medical Insurance Plan and Number
Family Doctor
Doctor's phone number

Area CodePhone Number

Submission Page

Please ensure you have thoroughly reviewed all information before clicking “submit” below. Any subsequent changes must be submitted via email to Edie Payne at epayne@carondeleths.org. Thank you for your attention to detail.
Should be Empty:

Corazón Retreat Date Confirmation Form