Central Minnesota TEC Application Form

Dates of Central Minnesota TEC Weekends: (Please choose one)

______ CM622 (Sat) Jan 15-(Mon) Jan 17, 2022 ______ CM623 (Sat) Feb 19-(Mon) Feb 21, 2022
______ CM624 (Sat) Mar 12-(Mon) Mar 14, 2022 ______ CM625 (Sat) Apr 09-(Mon) Apr 11, 2022
______ CM626 (Sat) Jun 25-(Mon) Jun 27, 2022 ______ CM627 (Wed) Jul 13-(Fri) Jul 15, 2022
______ CM628 (Fri) Aug 12-(Sun) Aug 14, 2022

The retreat begins at 9:30 AM the first day and concludes at 5:00 PM the third day.

Name ________________________________________ Sex___ Birthday________*Age_____

Preferred Name on Name Tag________________________ Email:_____________________

Permanent Address ____________________________________________________________

City__________________________ State_________ Zip________ Phone_______________

Emergency Phone Number while attending TEC:__________________

Address Used During School Year ______________________________________________

City__________________________ State_________ Zip________ Phone_______________

Marital Status ________________________ Spouse's Name ________________________

Religion___________________ School__________________________ Grad Year________

Parish___________________________________ Pastor______________________________

Parish Address______________________________ City__________ State___ Zip _____

Parent's Name_________________________________________________________________

Do you have any special dietary or health needs? _____________________________

How did you find out about TEC?(Please use specific names) _________________________________________________

*Age: Must be at least 16 years old to attend.

___ I attest that I have read and agree to CM TEC’s COVID-19 Policy and Procedure:
Because we are in a congregate setting - eating, praying, lodging, and gathering for multiple days – all TEC participants must be vaccinated against COVID-19 or receive negative results for a COVID-19 test administered within 2 days prior to arrival at the TEC center. We will provide more information about this process and how to submit proof to those who register for a TEC retreat. Masks are not required on the retreat.

Total cost of weekend is $95. Please attach a non-refundable $30 registration deposit and
mail this form to Central Minnesota TEC, PO Box 8, Andover, MN 55304.
Phone 320-532-4455. Weekends are held in Little Falls, MN.
Phone during a weekend 320-632-1675.  Once your application is submitted you can assume you
have been accepted. Exceptions will be notified by mail immediately.  A letter with full
details regarding the retreat will be sent to you two weeks prior to your weekend.

If you are a student living at home, please ask your parent or guardian to sign this
application and medical waiver. In case of illness or injury, I authorize those in
charge of the TEC weekend that my son or daughter attends, to obtain whatever medial
assistance that seems necessary for his or her well being.

Signed by ___________________________________ Phone: _____________________