Read cover letter before submitting this application

 

Jefferson City CHRISTpower

2009

Specifics: Week long service retreat for high school teens

Location:  St. Michael’s – Russellville

Date:        July 12-18, 2009

Cost:        $150, of which $50 non-refundable deposit is due with application-payable to:

                 St. Joseph Cathedral - CHRISTpower

Deadline:  May 11, 2009  Slots will be filled on a “first-come-first-to-serve” basis.

                 Return application  & $50 non-refundable deposit ASAP to:

                 Ginny Bockwinkel, 922 Country Ridge Drive, Jefferson City, MO 65109

 

CHRISTpower

Application

 

1)FULL NAME:________________________________________________________________

                                                                                                                                          Nickname

 

2)ADDRESS:__________________________________________________________________

                                                                                         City                                 State                           Zip

 

3) Male_______Female____                    Grade: Frosh:_____Soph:______Jr.:______Sr.:______

                                                                                   ‘08-’09 school year

4)HOME PHONE___________________________E-MAIL ____________________________

 

5)ALTERNATE ADDRESSES____________________________________________________

 

6)ALTERNATE PHONE #_______________________________________________________

  

ALTERNATE PHONE #_________________________________________________________

 

7)PARISH_____________________________________________________________________

 

8)HEALTH CONDITIONS:

ALLERGIES_____________________________SPECIAL DIET________________________

 

MEDICINES (Rx)______________________________________________________________

 

9)REFERENCE #1____________________________________________________________

                                                                                                            Phone Number

    REFERENCE #2______________________________________________________________

                                                                                                            Phone Number

 

 

                                           LIMITED SPACE AVAILABLE!

                                     

 

 

 

 

                                                                                                                               (OVER)

                                                                                                                           

 

ADDITIONAL INFORMATION

 

1)EXPERIENCE WITH MANUAL LABOR:________________________________________

i.e – hammering, sawing, painting, hedge trimming, etc.

______________________________________________________________________________

 

 

 

2)WHAT TYPE OF NON-MANUAL SERVICE HAVE YOU PERFORMED IN THE PAST?

 

 

 

 

 

 

3)WHAT IS A CURRENT CONCERN IN YOUR LIFE THAT YOU MIGHT WANT ADDRESSED/DISCUSSED ON THIS RETREAT?

 

 

 

 

 

 

4) WHAT ROLE DOES GOD PLAY IN YOUR LIFE NOW AND HOW DO YOU HOPE TO DEEPEN THAT RELATIONSHIP SO THAT YOU ARE CLOSER TO HIM 5 YEARS FROM NOW?

 

 

 

 

 

5)WHY WOULD YOU LIKE TO PARTICIPATE IN CHRISTpower?

 

 

 

 

 

TEE-SHIRT SIZE (Teen)     _______S  _______M  _______L  _______XL  _______(Other, specify)

 

PARENTS

 

______       Number from your family (other than the participating teen) who will be 

                    attending the dinner on Wednesday evening, “Family Night”(mass begins at

                    5:30PM)