Teen Retreat Facilitator Registration Form

  • Teen Retreat Facilitator Registration

  • Participant Information

  • Parent / Guardian Information

  • Emergency / Medical Information

  • Please note any special medical problems, allergies, food sensitivities or ability limitations/needs that the chaperones will need to be aware of.
    Over the counter medication for first aid: Ibuprofen (Advil) , Aspirin, (Antihistamine) Benadryl, Antacid (Tums)
  • Teen Code of Conduct – SIGNATURE REQUIRED

    In signing below, I agree to abide by all policies and rules established for this event. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the event and being sent home at my parent’s expense. Basic rules/expectations include, but are not limited to, the following: Respect for all adult leaders, peers, and all property; No illegal drugs, alcohol, underage smoking, firearms, explosives, or other illegal substances; Males and females are to remain in separate sleeping spaces at all times; No inappropriate physical/sexual activity; Appropriate attire to be worn at all times. Other guidelines may be set forth accordingly by adult chaperones present for the event.
  • MM slash DD slash YYYY
  • Parent Release – SIGNATURE REQUIRED

    In consideration for being accepted and allowed to participate in this retreat and activities associated with its program and location, I (Parent/Guardian above) grant permission for my child (Participant above) to participate in this parish youth ministry event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from the parish. A brief description of the activity is given above. As parent and/or legal guardian, I assume and remain legally responsible for any personal actions taken by my child. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to release hold harmless, and defend His Camp, Inc., Camp Gideon, their trustees, Board, employees, and agents (“His Camp”), and The Catholic Church of the Transfiguration, its officers, directors and agents, and the Archdiocese of Atlanta, Georgia, chaperones, or representatives associated with the event from any claim, demand, action, or cause of action due to loss, injury, damage to my child or my property arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Atlanta, chaperons, or representative associated with the event for reasonable attorney’s fees and expenses arising in connection therewith. Should any dispute or controversy arise with “His Camp”, I agree to seek resolution according to Biblical principles through the Christian Conciliation Service. I (Parent/Guardian above) grant permission for a parish representative to transport my child (Participant above) to the nearest hospital or medical facility in the event of a medical emergency.
  • MM slash DD slash YYYY
  • Section Break