LA/SGV Search at 8301 Arroyo Dr, Rosemead, CA 91770 US - Search Application
| Search Application |
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| Please print this application to join us on the next Search Weekend |
LA/SGV Search for Christian Maturity Please complete this application for the Search Weekend fully and clearly. Please mail your application to the address below, 2 weeks prior to the retreat date so that we may contact you with information ragarding the retreat.
Name: ___________________________ Age: _________ Sex: M or F
Address:________________________________City/Zip___________________
Phone No.:________________________________
School/Occupation__________________________
Birthdate:________ Religion: _______________Practicing? YES or NO
Church or Parish:_______________________________
Sponsor's Name:_______________________________
Sponsor's Phone # :____________________________
Why do you want to make a Search? ___________________________________________________________________________
___________________________________________________________________________
Do you have any special interests or talents? (Please feel free to bring your musical instruments) ___________________________________________________________________________
Have you experienced any other retreats? If so. Please specify ( ex: YES, LIFE, CHOICE, etc)
___________________________________________________________________________
Do you require a special diet? If so. Please explain.
___________________________________________________________________________
ALL APPLICANTS BE 18 YEARS OF AGE OR OLDER
Los Angeles/San Gabriel Valley Search is a non-profit organization. The cost of the Weekend is $80.00. A $20.00 deposit must accompany this Application. The remaining balance is due in CASH at the time of your arrival. If you are unable to attend, the deadline for a refund of the deposit is the Sunday before the Search Weekend. All payments must be made in CASH ONLY. For further information, please contact: Dante and Marie Pignotti (909) 596-1865
LA/SGV Search for Christian Maturity P.O. Box 1756, Rosemead CA 91770 - Fax (626)280-0545
EMERGENCY INFORMATION PLEASE COMPLETE ALL PARTS
Father/Spouse Name________________________________________
Address: __________________________________
City/Zip ___________________________________
Home Phone: _____________________________
Business Phone:___________________________
(IF DIFFERENT FROM ABOVE)
Mother/Spouse Name________________________________________
Address: __________________________________
City/Zip: __________________________________
Home Phone: _____________________________
Business Phone: __________________________
MEDICAL AUTHORIZATION FORM
I _______________________________, in the event of any sickness or accident, authorize the calling of a doctor and/or the provision of other medical services assuming all liability. In addition, I will not hold Los Angeles/San Gabriel Valley Search, its officers, leaders, or St. Joseph’s Salesian Youth Center liable for medical and other expenses incurred.
Date: _________ Signed: ______________________________________
IF YOU ARE TAKING PRESCIBED MEDICATION(S), PLEASE LIST ALLERGIES TO ANY MEDICATIONS: ________________________________________________________________
Other Allergies:__________________________________________________
LA/SGV SEARCH IS NOT RESPONSIBLE FOR THE LOSS OF PERSONAL ITEMS ON THE WEEKEND. PLEASE DO NOT BRING RADIOS, CLOCKS, CELL PHONES, PAGERS, COMPUTERS, OR ANY VALUABLES, COME TO RELAX!!