Adult Kairos (30-40) – Male – ECRC – Eastern Catholic Re-Evangelization Center

All fields are required to submit application.

Retreatant Information:

Name*

First Last

Are you Chaldean?*

At which Church (Parish) were you baptized?*

What is your current home parish?*

Are you currently involved in a pending legal matter, court case, probation, parole, restraining order, or otherwise?*

Please explain the legal matter

Do you have any serious food allergies or medical conditions that may require special precautions?*

Please explain your allergies or medical conditions

Home Phone*

Cell Phone*

Email*

Enter Email Confirm Email

DOB*

Parental Information

[This portion is required for ECRC records]

Parents Deceased*

No
Yes

Which parent?

Mother is deceased
Father is deceased
Both are deceased

Mother's Name*

First Last

Mother's Phone Number*

Father's Name*

First Last

Father's Phone Number*

Do you need a scholarship?*

No
Yes

Please enter your scholarship number below*

If you do not have a scholarship number, please call 248-538-9903

Payment Options*

3 Month Payment ($100)
Paid in Full ($300)

Total

$0.00

Credit Card*

American Express

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Terms & Conditions*

Please read the terms and conditions below carefully! By checking the box, you confirm that you have read the terms and conditions, that you understand them and that you agree to be bound by them.

There is a certain behavior and certain expectations that are encouraged on the journey. I understand that this journey is to focus on my personal relationship with God. I agree that if I am found in possession of or participating in any way with drugs or alcohol, I will be sent home immediately at my expense. I further understand that this is a retreat and I am expected to participate in all planned meetings and activities and abide by all rules.

This application is merely an offer for acceptance into the Kairos Retreat. Submitting this application is non-binding upon [ECRC] and does not guarantee that the applicant will be permitted into the retreat. Applicant acknowledges and agrees that [ECRC] has the absolute authority to revoke this application and its acceptance of this application at any time, with or without notice, and for any reason or no reason at all. Furthermore, Applicant, on behalf of himself or herself and on behalf of his or her administrators, executors, agents, personal representatives, and family (collectively with Applicant, the “Applicant Parties”), hereby agree to forever release, forever discharge, waive, and abandon ECRC, and its volunteers, leaders, priests, agents, attorney’s and representatives from any and all claims, demands, suits, controversies, disputes, actions and causes of action now existing or hereafter arising, in law or in equity, known or unknown, contingent or liquidated, arising out of or in any way connected with the this Application and/or Applicant’s participation in and attendance at the Kairos Retreat.

Adult Kairos (30-40) – Male

Mature Adult Kairos - Male 30-40 - Winter

Retreatant Information:

Parental Information