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Nuevo: La Fe Ortodoxo Cristiana
Staff & Chaperone Application

PRO-ORB: Orthodox Youth Retreat

 Staff Chaperone/Adult Volunteer Application         

Name: _________________________________

Social Security Number: __________________

 

M or F? ____ Date of Birth: _________

Marital Status: ______________

 

Address: _______________________________

________________________________________________________________________________

 

 

Home Phone: ____________________________

Work Phone: ____________________________

E-Mail: _________________________________

 

Do you have a valid driver’s license? YES NO

 

If yes, License state and #: ________________

 

Emergency Contact: _____________________

Address: _______________________________

________________________________________

 

Contact Phone: __________________________

Relationship: ____________________________

 

Employment

Name of Employer: __________________________

_______________________________________

 

Address: ________________________________

________________________________________

 

Position ______________________________

 

Length of Employment: ___________________

 

Supervisor: ___________________________

 

Phone: _________________________________

 

Church Membership

Parish:______________________________     

 

Address: ____________________________

 

Diocese: _____________________________

 

How many years attending? ____________

 

Priest: ______________________________

 

Priest’s Phone: _______________________

 

References

Name

 

Address

 

Phone

 

Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

Have You Ever Been Charged or Convicted of a Felony Offense?  Yes______           No_______

Circle All areas which best meet your Interests and Abilities:

Choir/Reader/Server     Nurse/Health               Kitchen: Cooking & Prep                    Water Safety/Lifeguard                Sports

Arts/Crafts/Games               Dorm Chaperone/Parent     Maintenance/Clean-up       Other: _________________________

 

Staff Fee:  $225.00/person (Covers all local lodging, meals, fees & local transportation costs)

Please enclose your payment & completed form and mail it to:

Winter Service Retreat 2009-2010

c/o St. George’s Orthodox Church

P.O. Box 667

Pharr, Texas USA 78577

PS  If your entire family is planning to come, please let us know as this will necessitate special arrangements for lodgings, meals, outings, etc. Family participants and families with younger siblings can either stay at the on-site motel-type lodgings at the Valley Baptist Retreat Center or may provide for their own lodging at a nearby motel. See Local Accomodations section for additional details.

 

 

 

¡Gloria a Dios por todo!
Direct your Questions, Comments or Feedback to (Por favor dirigir sus preguntas, dudas o comentarios al): 956-781-6114 or info@stgeorgepantry.org


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