(IF YOU PREFER TO MANUALLY REGISTER, CLICK HERE TO DOWNLOAD THE FORMS TO FILL OUT AND RETURN TO THE OFFICE.)

What: A weekend to help lead teens deeper into a personal relationship with Jesus. There will be music, talks, games, small groups, and a chance to break away from normal life and see what God has in store!

When: Saturday August 31- Monday Sept 2 (Labor Day Weekend) Check in at the Cenacle Saturday beginning at 3:30pm. We will return Monday around 1pm (*Please inform us of special travel arrangements if unable to be on buses)

Where: Camp Sweeney east of Gainesville

COST: $100 for lodging, food, transportation, and t-shirt.(Scholarship assistance available.)
***Failure to cancel one week in advance will result in no refund***

What To Bring: Clothes appropriate for weather conditions. (Please make sure all clothing is appropriate for a church retreat in style as well as any graphics or words. We ask that all shorts be “finger-tip” length.) You will also need bed linens (twin bed) or sleeping bag (with name on it), pillow, bath items, shower shoes, towel, and a Bible. Bring a swimsuit if you plan to swim, but ladies please bring a one-piece or colored shirt to cover your 2 piece suit. If you want you can bring a paintball gun or fishing pole for free time. You can also bring snacks. 

What Not To Bring: Any illegal drugs, alcohol, tobacco, or bad attitudes. Cell phones are not allowed at any time during the retreat. Drugs, alcohol, tobacco, bullying, or vandalism will not be tolerated and you will be sent home!

Qty
Description
Amount
Total
1

$100.00
$100.00


Registrant Information
mm/dd/yyyy
PERMISSION TO TRAVEL:
I grant permission for my child, to participate in the below described parish event and youth activities. A brief description of the activity follows:
Description of event: St Ann High School Ministry Kickoff Retreat
Date of event: August 31- Sept 2
Destination of event: Camp Sweeney - just east of Gainesville,
Estimated time of departure and return: Check-in on August 31 at 3:30
pm; Return Sept 2 around 1pm
Mode of transportation to and from event: School Buses
I grant permission for my child, to travel in the above described parish event and youth activities by bus.
PLEASE INFORM US OF ANY SPECIAL TRAVEL ARRANGEMENTS:
Consent To Participate and Liability Release
In consideration for allowing Youth to participate in this activity, I / We, the parent(s)/guardian(s)/conservator(s) of Youth grant permission for Youth to travel to and participate in the Event described above. I/we assume all risks and hazards incidental to Youth's participation in the Event, including transportation to and from the Event. In consideration for allowing Youth to participate in the event listed above, and on behalf of myself/ourselves and Youth's parents, legal guardians, siblings, heirs, assigns, and personal representatives, I/we hereby release and agree to fully and unconditionally protect, indemnify, and defend the Parish, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Youth) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to Youth's participation in the Event, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, attorneys’ fees, and expenses incurred by the prevailing party.
I, the parent/guardian/conservator grant permission for my son/daughter to participate in the Kickoff Retreat August 31- September 2, 2019 at Camp Sweeney.
Authorization of Consent to Treat Minor
I am the parent/guardian or/conservator for my son/daughter, , a minor, and as such do hereby authorize St Ann Catholic Church, its youth ministry leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. It is understood that this authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment, or hospital care which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of Chapter 32 of the Texas Family Code. This authorization shall remain effective throughout the specific event dates listed above. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I hereby release, defend and hold harmless the Parish and Roman Catholic Diocese of Dallas (Diocese), their officers, directors, agents, employees, volunteers, youth ministry leaders, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions
I have read this consent for medical treatment of a minor statement, and I understand and voluntarily agree to its provisions.
Audio/Visual Recording and Photography Consent
On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. For good and valuable consideration, I hereby grant to St Ann Catholic Church the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child, or images in which me/my minor child may be included, now existing or hereafter made, in any case, with or without identifying subject for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same.

I consent/do not consent (check one below) to the use of such materials in which my child may appear. I hereby release and agree to fully and unconditionally protect, indemnify, and defend St Ann Catholic Church (parish), the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Youth) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of my child, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES.
Insurance Information
Medications: CHECK All that Apply – Note: DO NOT CHECK ALL AREAS AS ONE MAY CANCEL OUT ANOTHER
This child takes no medication and will bring no medication with him/her.
This child takes medication/s and will self-medicate. The child will bring all such medications necessary, and such medications will be clearly labeled. I understand that the child will be required to turn all medication(s) over to a supervising adult designated to keep medication(s). I further understand that it will be this child’s responsibility to present himself/herself at a location designated for returning medication(s) to this child at the frequencies/times listed below. I understand that the adult to whom this child surrenders the medication has no medical training and this adult will not measure dosages. This child will return the medication(s) to the adult after he/she self-medicates. At the conclusion of the event it will be this child’s responsibility to pick up remaining medication(s), if any, at the self-medication designated location. Names of medications and exact dosage and frequencies/times are as listed below:
NOTE: Should your child have an Emergency Injection Device (Epi-Pen), Diabetic Condition, Asthmatics with a rescue inhaler, or other special medical condition, it is important to provide a clear description as to the nature of the medical condition and any medication. This is important for situations where the youth becomes unable to self-administer these treatments and to communicate with Emergency Response Personnel. If a child, who is normally able to self-administer these medications becomes unable to self-administer or is in distress, youth ministers, volunteers, or other parish personnel will immediately call 911 to summon Emergency Medical Personnel to respond to the medical emergency. Youth ministers, volunteers, and other parish personnel are NOT trained to administer these types of emergency medications.
This child takes medication but is unable to self-medicate. The child’s parent/guardian/conservator will provide and dispense any and all needed medications.
No medication of any type whether prescription or nonprescription may be administered to this child unless the situation is life-threatening and emergency treatment is required.
"Over the Counter" Medication Release:
I grant permission for the following nonprescription medication to be given to this child:
Specific Medical Information
(medications, foods, plants, insects, etc.)
(date of last tetanus/diphtheria immunization)
(such as mumps, measles, chicken pox, etc.)
Any other special medical conditions of this youth that we should be aware of?
Parent/Guardian/Conservator Information
Payer Information
This is the address where your credit card statements are mailed.
A receipt will be e-mailed to this address.
Your Payment Information

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