RC Activities, Inc

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

ECYD 7th & 8th Grade Boys Spring Retreat

Join ECYD members for this retreat to renew our friendship with Christ and enjoy friendships, sports, night games, and forge the virtue of Generosity.

WHO:	Rising 7^th- 8^th grade boys
WHEN:	March 31 - April 2, 2023
WHERE:	Lifeteen Camp Hidden Lake - 830 Hidden Lake Rd, Dahlonega, GA 30533
COST:	$180.00 per boy
CONTACT:	For info or questions - Fr. Michael O'Connor, LC here or Kenneth Farnsworth here

Registration for 7th & 8th Grade Retreat 2023

Qty

Description

Amount

Total

Registration Fee for ECYD Fall Retreat

$180.00

Administrative Code

---

Would you be willing to make a donation towards the daily expenses of the Legionaries of Christ who run the retreat?

$25

$50

$100

Other Donation Amount

Total: $180.00

Participant Information

Participant #1

First Name: *

Last Name: *

Email:

Date of Birth: *

School:

Current Grade/Other: *

Parish:

Medical Conditions/Allergies

Medications:

Blood Type:

Special Needs and/or Requests:

EMERGENCY CONTACT INFORMATION

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Name #2:

Emergency Contact Phone #2:

PERMISSION FORM

PLEASE MAKE SURE TO COMPLETE AND DIGITALLY SIGN
AT LEAST 1 PERMISSION FORM BELOW.

NATURE AND DURATION OF ACTIVITIES: March 31 - April 2, 2023; ECYD Boys Spring Retreat, 7^th-8^th grade. A weekend retreat including Mass, talks, confession, dynamic activities, field sports, and swimming.
ACTIVITY SUPERVISORS: Fr. Patrick O’Loughlin, LC; Fr. Michael O'Connor, LC; Kenneth Farnsworth.
TRANSPORTATION: Transportation is not provided. Participants are responsible for securing their own transportation to and from the event, as well as to various locations during the event.
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).
REQUIREMENTS: The child/child(s) named above are in good health and have 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 fields above.
CONSENT: I/We hereby consent to the above-named child/child(s) participation in the activities described above including mentoring, and specifically request that she 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/child(s) 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/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/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/child(s). I/We represent that the child/child(s) 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/child(s) injury.
EMERGENCIES: If the above-named child/child(s) 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/child(s) blood type, allergies, or other medical problems (if any) are listed above.
EMERGENCY CONTACTS: In the event of a medical or other emergency, the above named participant/s authorizes the activity supervisor(s) to contact the emergency contacts listed on the registration form.
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.

NATURE AND DURATION OF ACTIVITIES: Date: March 31 – April 2, 2023. ECYD Boys Spring Retreat. 7^th and 8^th Grade. A weekend adventure retreat including Mass, talks, confession, dynamic activities, field sports, and swimming.
ACTIVITY SUPERVISOR(S): Fr. Patrick O’Loughlin LC; Fr. Michael O’Connor, LC; Kenneth Farnsworth.
TRANSPORTATION: Transportation is not provided. Participants are responsible for arranging their own transportation to and from the mission.
REQUIREMENTS: The participant named above/here 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 participant. Specific allergies and medical problems should be indicated in the appropriate fields above.
CONSENT: The participant named above/here certifies that he/she is above the age of majority and hereby consents to participate in the activities described above, and specifically requests that he/she be allowed to participate in those activities.
AUTHORIZATION: The participant named above/here hereby authorizes RC Activities, Inc. to use the image and likeness of him/her 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 his/her image and likeness on website of RC Activities, Inc. or its successor in operation or affiliated organization(s) upon written consent of RC Activities, Inc. The participant named above/here understands that this authorization shall survive the end of his/her participation in the activities referenced on this form.
INSURANCE: The participant named above/here understands that RC Activities, Inc. does not carry any insurance relative to the activities or for any injury that may occur to him/her. The participant named above/here represents that he/she is (a) covered by insurance through his/her own insurance carrier; or (b) that he/she is personally financially responsible for any and all medical costs incurred as a result of injury.
EMERGENCIES: If The participant named above/here requires any emergency medical procedures or treatments during the activities, he/she consents 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, the above-named participant’s blood type allergies or other medical problems (if any) are listed above.
EMERGENCY CONTACTS: In the event of a medical or other emergency, The participant named above/here authorizes the activity supervisor(s) to contact the emergency contacts listed here on the registration form.
RELEASE AND INDEMNIFICATION: I 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 parent or guardian, any sibling, 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 participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I understand that this release and indemnification shall survive the end of my participation in the activities referenced on this form and shall have no limitation in time or amount.