Bishop Shanahan High School

Registrant Information

Retreat Date: *

Parent/Guardian 1 First Name: *

Parent/Guardian 1 Last Name: *

Parent/Guardian 1 Phone: *

Parent/Guardian 1 Email: *

Parent/Guardian 2 First Name: *

Parent/Guardian 2 Last Name: *

Parent/Guardian 2 Phone: *

Parent/Guardian 2 Email: *

Student First Name: *

Student Last Name: *

Student Gender: *

Student Grade Level: *

Student’s School: *

Parish: *

Liability: *

I understand that in order to ensure a safe, secure and respectful environment, a student participant is expected to behave in a manner which reflects Christian virtue and Gospel values. Any behavior which is contrary to the teachings of Jesus Christ will not be tolerated. Appropriate disciplinary actions will be taken by the Retreat Director which may include the immediate dismissal of the student participant. Inappropriate behaviors include but are not limited to bullying, harassment, intimidation, threats to Ignite staff and/or student participants, vandalism and/or the carrying of contraband. Back packs are permitted. If, however, there is a reasonable suspicion that the student participant is carrying contraband, the Ignite Retreat staff will search the back pack and seize the contraband. Contraband includes but is not limited to illegal drugs, drug paraphernalia, weapons, and alcohol. If the student participant refuses to cooperate or the contraband discovered poses immediate danger to others, the police will be notified. For safety reasons, student participants are permitted to carry their own cell phone, but may not use them during the day. The cell phone may be confiscated if this policy is violated. No other electronic devices are permitted.

Medical Information: *

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reach, I authorize a call may be made to 911 for emergency medical attention.

Media Release: *

Bishop Shanahan High School and the Archdiocese of Philadelphia have my permission to use my child’s photograph publicly to promote the Ignite Retreat. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Additional Information:

Are there any additional comments or information that we should know (ex. Allergies, IEPs, etc.)?