Junior catholic daughters of the americas texas state court



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JUNIOR CATHOLIC DAUGHTERS OF THE AMERICAS TEXAS STATE COURT

TO: JCDA State Board

JCDA Chairmen

CDA National Director

CDA State Officers

CDA District Deputies

CDA Regents

FROM: Terri Beltran

State Youth/JCDA Chairman


DATE: March 22, 2012
RE: JCDA Spiritual Retreat – June 9, 2012

The Junior Catholic Daughters of the Americas will be hosting a one day Spiritual Retreat on

June 9, 2012 at Father John Peter’s farm in Weimar, TX. Our main concern is for the safety of our children. JCDA must be in compliance with the Victoria Diocesan Safe Environment Polices and Procedures for child and youth protection. For those attending from other dioceses they must comply with their Diocesan Safe Environment Polices and Procedures. I strongly encourage each local court attending the retreat to provide proof of the adults attending that they have been certified with Safe Environment in their diocese.

Sincerely,

Terri Beltran

State CDA Youth/JCDA Chairman

P. O. Box 407

El Campo, TX 77437

tabeltran@ecisd.org

979-543-7067 8-4 ~ (361)554-7506 ~ tabeltran@ecisd.org






REGISTRATION FORM

TEXAS JCDA

SPIRITUAL RETREAT

FR. JOHN’S RANCH – WEIMAR, TX

SATURDAY – JUNE 9, 2012





JUNIOR □ JUNIORETTE □
Name: ______________________________________________________________Date__________________

Address: ____________________________________________________________Ph. # _________________

Street City Zip
Court Name ________________________________________Court # ______ Email_____________________
† † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † †
Name: _______________________________________ CHAIRMAN□ ADULT LEADER□ PARENT □

Address: _________________________________________________Ph. # ____________________________

Street City Zip
Email ________________________________________Cell Phone # _________________________________
† † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † † †
Registration closes on May 28, 2012 Cost: $5.00/person. This includes lunch and drinks
We are taking the first 125 who sign up (including adults)
Please mail to:

Terri Beltran, State CDA Youth/JCDA Chairman

P. O. Box 407

El Campo, TX 77437

tabeltran@ecisd.org

979-543-7067 work hours from 8-5 ~ (361)554-7506 ~ tabeltran@ecisd.org

Please duplicate this form for each member attending the retreat. Medical release forms must accompany registration forms.

For directions to the retreat call Father John Peters @ 361-798-5888 or email him @ rectory@shcatholicchurch.org


TEXAS

JUNIOR CATHOLIC DAUGHTERS

OF THE AMERICAS

State Court Consent Form and Liability Waiver
Members Name:_______­­­­­­­­­­­________________________________________________Date of Birth:__________________
Parent(s)/Guardians Name: __________________________________________Relationship:___________________________
Home Address: ________________________________________City & Zip Code: ____________________________________
Home Ph#:__________________________________ Cell #:_________________________________ Email________________

LIABILITY RELEASE AND WAIVER

I (parent/guardian) _____________________________________________________________do by release the following

(Please print)

from any and all liability while my child is in attendance at any and all JCDA functions/activities: Carolyn Malik/CDA State Regent, Terri Beltran/State JCDA Chairman, Rev. John Peters/State Chaplain, and the local Catholic Diocese(s) hosting Parishes, groups and or facilities.
Transportation (If applicable)

I give my permission for my daughter to ride with ______________________________to the planned JCDA function, in Weimar, TX. __________________________________________________________________________________________ Parent/Guardian Signature
MEDICAL INFORMATION and RELEASE

In the event of an emergency, I hereby give permission for transportation of my child to a hospital for emergency medical treatment. I wish to be advised prior to any treatment by the hospital or doctor. In the event of an emergency and you are unable to reach me contact:

Emergency Contacts:

Name: __________________________________________________ Relationship: _____________Number:_____________
Name: __________________________________________________ Relationship: _____________Number:_____________
Family Doctor: ___________________________________________Phone#:_______________________________________

Does your daughter have any medical problems we should be aware of? Yes □ No □ If yes, please list them.

______________________________________________________________________________________________________

List any prescription medications that your child is taking or may need during the course of the day. Please be sure the name of the medication, the dosage and frequency are listed on the medication.

______________________________________________________________________________________________________
YES □ NO□ I have special dietary needs_____________________________________________________
Date of the tetanus/diphtheria immunization: _______________________________________________________________

Is your daughter allergic to any medications? Yes □ No □ if yes, please list. ____________________________________
I hereby grant permission for non-prescription medications (such as Tylenol, throat lozenges, cough syrup) be given to my daughter. Signature: ___________________________________________________ Date_______________________

I fully understand the forgoing statement and sign this Parent/Guardian Consent and Liability Waiver From knowingly, freely, and willingly.

Signature: ____________________________________________________ Date_______________________

Please provide copy of insurance carrier and attach to this form
INSURANCE INFORMATION ______ No, I do not carry medical insurance at this time.
Insurance Carrier: _____________________________________ Name of Insured: ______________________________
Insurance Policy Number: ____________________________________________________________________________
Father’s Name______________________________________ Day Phone: ____________________________________
Mother’s Name: _____________________________________Day Phone: _____________________________________
In the event it comes to the attention of the chaperone(s) associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately. If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and sign this Parental/Guardian Medial Consent Waiver knowingly, freely, and willingly.
________________________________________________________________________ ______________________ Signature (Parent/Guardian) Parent/Guardian must sign for anyone under 18 years of age. Date
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
PHOTO RELEASE

I agree to allow my daughter to be photographed for publicity purposes for the Junior Catholic Daughters of the Americas (JCDA) organization.


I understand that the photo may be used for display, publication, video, or by other media, such as local newspapers and/or television stations. In some instances, photos may be used on the JCDA web site. Children will be identified by first name only on the web.
___________________________________ __________________

Signature of parent or guardian Date


___________________________________ ___________________________________

Name of JCDA member JCDA Court No.







Texas STATE JCDA

Spiritual Retreat

Fr. John’s Ranch in Weimar, Texas

Saturday, June 9, 2012

Times: Saturday 10:00 a.m. - 4:00 p.m.

Check-in time: Saturday 9:00 a.m. - 9:30 a.m.



TO JESUS THROUGH MARY”

Message Service Community

Welcome…………………………………………….….Mary Adamek, State JCDA President
Prayer/Pledge of Allegiance…………………………….Katelyn Martinez, State JCDA 1st V-President

Introductions of Guests and Speakers………………..…Mary Adamek, State JCDA President

ICE BREAKERS…………………………………………JCDA STATE OFFICERS
TALK………………………………………………………Sharon Patek
MASS………………………………………………………Rev. John Peters
LUNCH……………………………………………………BREAK
TALK……………………………………………………....ACTIVITIES Juniors - JCDA State Officers

Juniorettes – JCDA State Moms

EVALUATION FORMS
FAREWELL……………………………………………….Terri Beltran/Father John
DRESS ATTIRE:

Wear comfortable clothing for outdoors, T-shirts with blue jeans, khakis, or Capris and tennis shoes. Bring sunscreen and a towel, there will be water games - swimsuits may be worn under t-shirts. Remember to be modest. We are all respectable young ladies.



T-SHIRTS $10.00 ~ BAGS $10.00 ~ BEARS $10.00

CUPS $2.00~ST PINS $5.00 ~ ST CHARMS $6.00


For directions to the retreat call

Father John Peters:

Rectory: 361-798-5888

Cell: 361-798-6479



email him @ rectory@shcatholicchurch.org


EAST


WEST


SOUTH

For those traveling here is the hotel information: Days Inn Weimar 102 Townsend Drive Weimar, TX 78962 1-979-725-9700









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