RC Activities - Acceptiva

IF YOU WOULD LIKE TO PAY BY CREDIT CARD PLEASE CLICK HERE:
Girl’s HS Spex 2018 Registration BY CREDIT CARD.

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

This is a weekend of preached talks and meditations based on the spiritual exercises of St. Ignatius Loyola. Including: guided reflections, personal time for prayer, mass, opportunities for confession and spiritual direction. Our retreat team is made up of Regnum Christi Mission Corps volunteers, Consecrated Women of Regnum Christi, and a Legionary of Christ Chaplain.

Where: Our Lady of Bethesda Retreat Center 7007 Bradley Blvd. Bethesda, MD 20817

When: November 30 - December 2

For more info contact:ecydactivitiesdc@gmail.com

Registration

Qty

Description

Cost - $225

Participant Information

Participant #1 Name: *

Date of Birth (mm/dd/yyyy): *

Grade: *

School: *

Blood Type: *

Comments/Allergies:

PERMISSION TO PARTICIPATE IN CLUB ACTIVITIES,
MISSION NETWORK ACTIVITIES, USA, INC.

NATURE AND DURATION OF ACTIVITIES: An overnight silent retreat at the Our Lady of Bethesda Retreat Center in Bethesda, MD November 30 -December 2. Retreat will include catholic formation talks, moments of silent prayer, mass, and opportunities for confession and mentoring.

ACTIVITY SUPERVISOR(S): Amelia Hoover, Helen Yalbir, and year-long volunteers, Regnum Christi Missionaries.

TRANSPORTATION: Not Applicable. Participants are responsible for securing their own transportation to and from activities, as the company does not provide transportation.

MENTORING: Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in club activities. Mentoring involves a one-on-one conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser). 5. REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section 9 below.

REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in section 9 below.

CONSENT: I/We hereby consent to the above-named child's participation in the activities described above including mentoring, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have full authority to legally consent to her participation in the activities described on this form, and all provisions contained herein.

AUTHORIZATION: I/We hereby authorize RC Activities, Inc. to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by RC Activities, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of RC Activities, Inc., or its successor in operation or affiliated organization(s) upon written consent of RC Activities, Inc. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.

INSURANCE: I/We understand that RC Activities, Inc. does not carry any health insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/We am/are personally financially responsible for any and all medical costs incurred as a result of the child's injury.

EMERGENCIES: If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child's blood type allergies or other medical problems (if any) are listed below:

EMERGENCY CONTACTS

If, in the event of a medical or other emergency, I/We am/are unable to be reached by telephone at the numbers listed below, I/We authorize the activity supervisor(s) to attempt to contact me/us through the alternative emergency contacts listed below.

Emergency Contact 1: *

Relation: *

Home Phone: *

Cell Phone: *

Emergency Contact 2: *

Relation: *

Home Phone: *

Cell Phone: *

RELEASE AND INDEMNIFICATION

I/We release and waive, and further agree to indemnify, hold harmless or reimburse RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., the individual members, agents, directors, officers, employees, volunteers and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorneys’ fees incurred by RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damages or injuries arising out of, during, or in connection with my/our child's participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced on this form and shall have no limitation in time or amount.

Waiver: *

I have read and understand the above permission form in its entirety, and also understand that it is a legal document and I agree and consent to all terms and conditions contained within.

By typing my full name in the box below, I agree and consider this as my electronic signature which is valid in a court of law.

Sign by entering full name: *

Your Information

First Name: *

Last Name: *

Spouse’s Name:

Address: *

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

Cell Phone:

E-mail: *

A receipt will be e-mailed to this address.