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)
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)
______ 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)