Participant Name *

First Name

Last Name

Gender *

Male

Female

Status for Retreat

Participant

Team Member

Participant Phone

(###)

###

####

Photo Consent *

From time to time, photographs and video, writing for blogs, or visual art (images of work). Holy Redeemer would like to able to use these for flyers, parish websites, and the like.*

I authorize and give full consent, without limitation or reservation, to Holy Redeemer to publish any photograph, video/sound or image of work in which the above named youth appears while participating in any program associated with Holy Redeemer. There will be no compensation for use of any photograph, video/sound or image of work at the time of publication or in the future. If the youth and/or parent/guardian wish to rescind this agreement they may do so at any time with written notice.

I do not give consent.

Parents' Names *

First Name

Last Name

Parent's Phone *

(###)

###

####

Permission *

I give my permission for the above mentioned youth to attend a retreat with Holy Redeemer Catholic Parish

Yes

Transportation *

I will transport my own youth to and from the retreat and/or organize my own travel arrangements.

I can assist in driving youth other than my own teen to the retreat and am current with SEP training.

need to talk to the Faith Formation office about transportation.

Carpool Availability

I can transport there at 4pm from the parish to the retreat center.

I can transport back at 11:45am from the retreat center to the parish.

Youth Code of Conduct Agreement *

Please read through and check each statement as an acknowledgement of behavior expectations.

The Faith Formation Staff and adult chaperones are in charge of the retreat and its activities. If any emergency or unfortunate situation occurs, they are to be informed of it immediately.

The Faith Formation Staff and adult chaperones will set curfews on a nightly basis. There is to be no one outside of the designated sleeping area after curfew. If an emergency arises during the night, alert the adult sleeping closest to your room. Please make bathroom stops before going to bed.

Every person attending the retreat is expected to participate in all of the scheduled activities unless unable to do so because of physical injury or illness. Participants are not allowed to wander away from or leave the retreat premises without an adult chaperone or parent. Participants are expected to remain on the retreat premises throughout the entire weekend unless prior arrangements are made with the faith formation office.

Teens are not allowed to have firearms, knives, slingshots, or any other weapon, or fireworks of any type in their possession at any time during the retreat.

Under no circumstances may alcohol, tobacco of any kind, or drugs be part of any Holy Redeemer outing.

Any teen that cannot be controlled by the Faith Formation Staff or adult chaperones will not be tolerated. Parents will be contacted immediately and asked to come pick their student up—no matter what time, day or night.

All teens may need to perform important tasks that help the retreat run smoothly, so please do your part when asked.

During free time, youth will remain on the retreat premises and within the boundaries set by the adult chaperones. There will be some free time for each person’s rest and relaxation, but please be sure to follow the time limits that are set, so you do not delay any of the other activities of the retreat.

Any infraction of these guidelines may result in immediate contact of parents, and youth will be asked to return home at the cost and time of the parents or legal guardians no matter what time day or night

Clothing guidelines include: Shirts/tanks with at least a three-finger width at shoulders, no cleavage, midriff or bare backs, and no muscle shirts. Shorts must be longer than the longest finger fully extended, and skirts/dresses no shorter than 2” above the knee. No yoga pants or leggings worn as pants (you can wear them under other clothing). No clothing with alcohol, tobacco, or drug “ads,” no suggestive language, or curse words. For Swimsuits: No bikins or tankinis that have a middiff showing and no speedo bottoms for boys.

I have read these guidelines with my parents, and I agree to follow them. I understand that in the event that I fail to abide by them, appropriate means of reprimand will result. Also, I understand that at any time day or night, my parents may be contacted regarding my behavior and may be asked to come get me and take me home.

Emergency Consent for Treatment *

In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

Yes

Over the Counter Meds

I hereby grant permission for non-prescription medication such as aspirin, throat lozenges, cough syrup, to be given to my child, if deemed appropriate.

Yes

No