2022-2023 Fearless Ministries Priest and Religious Registraton

For Priests and Professed Religious Groups Only

Welcome to the Fearless Ministries team! We cannot offer the same experience to the teens without all of you.

Thank you for answering the call to bring the souls of the youth to the foot of the Cross in the Eucharist at Fearless Ministries Retreats...

Prefix: (please choose one) *

First Name: *

Last Name: *

If Other, please specify here:

Date of Birth:
mm/dd/yyyy *

Gender: *

Male

Female

Type of Clergy/ Religious *

Current Address:

City:

State

Zip Code:

Cell Phone Number:
xxx-xxx-xxxx *

Home Phone Number
xxx-xxx-xxxx

Email Address: *

Verify Email Address *

Emergency Contact Name

Emergency Contact Phone:

Parish or Order Name

Parish or Order City:

Parish or Order State:

Choose event(s): *

October 22, 2022 Kennedy Catholic, Somers, NY

Jan 13-16, 2023 Lake Champion, Glen Spey, NY

April 29, 2022 Kennedy Catholic, Somers, NY

Additional Comments about Availability:

Would you prefer for us to arrange housing for you on campus? *

Yes

No

Please select any items that would be of interest to you during the weekend:

If you are a member of the clergy, please send a copy to the Diocese in which the retreat will take place. In addition, please upload your letter of suitability here, or email it to: admin2@campveritas.com. Thank you!

Please check the box below to indicate that you understand the Safe Environment requirements as they pertain to Fearless Ministries, Inc.

I understand that it is my responsibility to comply fully with the Safe Environment Requirements of the Archdiocese of New York. I understand that these requirements include submitting to a background check. I also understand that I am expected to complete a Safe Environment training course as defined by the Archdiocese of New York (see our website, www.fearlessretreats.com for any further questions). *

I agree with the above

DECLARATION OF HEALTH/AGREEMENT TO HEALTH SCREENINGS/LIABILITY WAIVER

I, the undersigned, declare that upon arrival to the retreat, neither I nor anyone in my household has had or been in contact with anyone who has contracted COVID-19 for 5 days. I confirm that I will inform the Camp with all haste if that fact changes due to new information. I give permission to CAMP VERITAS to give me a health screening, the nature of which will be to determine risks for COVID-19, including but not be limited to, daily temperature checks and observation for symptoms commonly related with COVID-19.
I agree that if I must be dismissed from camp due to possible or confirmed contraction of COVID-19, I will release and hold harmless Fearless Ministries Inc., its founder, trustees, directors, officers, employees, agents, affiliates, volunteers and medical staff (“Staff”), for any and all claims for injuries, causes of action, or liability of any nature related to my participation in any activity occurring at the retreat, or on or around the physical site of the rented facilities . I attest that I will quarantine from any and all elderly and vulnerable persons for 5 days upon returning from the retreat. Furthermore, I agree to the same terms for risks as listed above for any and all persons with whom I come in contact.

*

I agree with the above

Signature: *

Today's Date: * +

Form Login Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.

2022-2023 Fearless Ministries Priest and Religious Registraton

****For Priests and Professed Religious Groups Only****

For Priests and Professed Religious Groups Only