Alumni Retreat

1
Name* This field is required.
First Name
Last Name
2
High School Graduation Year* This field is required.
Please Select
Please Select
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
3
Date of Birth* This field is required.
Date
Month
Day
Year
4
Email* This field is required.Please do not use your Molloy email.
5
Sex (for rooming purposes)* This field is required.
Please Select
Please Select
Male
Female
6
I would like to request a room for Friday night?* This field is required.There is no additional cost for staying on Friday. You may arrive between 6:00 pm and 11:00 pm and there be no food service. The retreat will start promptly on Saturday with Breakfast at 8:00 and Retreat Opening at 9:00.
Please Select
Please Select
Yes
No
7
Are you coming with your spouse? If so we will attempt procure a couples room but cannot promise)* This field is required.
Please Select
Please Select
Yes I am coming with a spouse and request a shared room
No I am coming by myself do not need a shared room with my spouse.
8
Retreat Date* This field is required.
9
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Cell Phone #* This field is required.
Please enter a valid phone number.
11
Emergency Name/Relationship
Name
Relationship
12
Emergency Contact Cell Phone #* This field is required.
Please enter a valid phone number.
13
Are you allergic to any medication? If so, which?
14
Are there any dietary needs/restrictions that we should be aware of and/or food that you cannot eat due to religious observance?
15
Consent - * This field is required.Name of Person Signing - I agree to release and save harmless Archbishop Molloy High School and the Marist Brothers and all of its employees from any and all liability for any and all harm arising as a result of this activity.
16
Photo Release* This field is required.I give permission for photographs or videos to be taken during the Archbishop High School Molloy Alumni Retreat Marist for use in development, fundraising, and public relationships materials and publications including internet web sites related to the Marist Brothers, Marist Youth Ministry and Evangelization, or Archbishop Molloy.
17
Cost* This field is required.
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Retreat Fee
Cost of retreat includes lodging, breakfast, lunch and dinner on Saturday, and breakfast on Sunday.
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18
Payment Type* This field is required.
Credit / Debit / Paypal
Only use this option with the approval of the Director of Campus Ministry and Marist Mission
19
Payment Methods
Debit Or Credit Card
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