(IF YOU PREFER TO MANUALLY REGISTER, CLICK HERE TO DOWNLOAD THE FORMS TO FILL OUT AND RETURN TO THE OFFICE.) WHO: All 9-12th grade men

WHAT: An awesome retreat just for the men to grow in community and in faith.

WHEN: Friday, June 28 – Saturday, June 29
We will begin at 7pm on Friday, the retreat will end on Saturday 4:30pm

WHERE: Here at St. Ann!

COST: $35 for food, retreat supplies, and t-shirt. Make check payable to “St Ann”.
We never want finances to prevent any youth from participating, various financial assistance options are available upon request

REGISTRATION DEADLINE: Wednesday, June 26th

WHAT TO BRING: Comfy clothes, sleeping bag and pillow, toothbrush, etc. There are no showers available. Also, please bring a snack to share!

WHAT NOT TO BRING: Illegal drugs, alcohol, tobacco… you know. You can bring your cell phone but please plan to not use it.

EMERGENCY CONTACT: Phil Ward ‭‭(214) 766-4756‬

Qty
Description
Amount
Total
1

$35.00
$35.00
PERMISSION TO TRAVEL
Description of event: St. Ann High School Ministry – Men's Retreat
Date of event: June 28-29, 2019
Destination of event: St. Ann
Teen or Parent responsible for travel to St. Ann.
I grant permission for my child to participate in the below described parish event and youth activities.
Consent To Participate and Liability Release
I grant permission for my son/daughter to participate in the Men's Retreat June 28-29, 2019.

I understand that as parent/guardian/conservator, I remain legally responsible for any personal actions taken by my son/daughter. I recognize the inherent risk associated with the various youth activities that my son/daughter will be participating in. I agree on behalf of myself, my son/daughter named herein, my heirs, successors, and assigns to indemnify, defend, and hold harmless St. Ann Catholic Church, and the Roman Catholic Diocese of Dallas, their employees and/or volunteers from any and all claims (unless due to the Sole or Gross NEGLIGENCE of the Parish) for illness, injury, death, and the cost of medical treatment therewith, arising from or in any way connected with my son/daughter participating in this retreat.

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, reasonable attorneys' fees and expenses incurred by the prevailing party.
I, the parent/guardian/conservator grant permission for my son/daughter to participate in the Men's Retreat June 28-29, 2019
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. As the State of Texas does not prevent audio or video recording or the photographing of children/youth (with the exception of Senate Bill 1, Section 26.009, which deals specifically with school districts), it does encourage parental consent. Additionally, current video recordings and photographs assist law enforcement agencies dealing with the Missing Children’s Program.

I consent/do not consent (check one below) to the use of such materials in which my child may appear. I release the staff and volunteers of St. Ann Catholic Church and the Roman Catholic Diocese of Dallas from any liability connected with the use of my child’s picture or audio/video recording as part of any of the above or similar activities.
Authorizatoin 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.
TEEN CURRENT MEDICATION - Check only one below
This youth takes no medication and will bring no medication with him/her.
This youth takes medication/s and will self-medicate. He/she will bring all such medications necessary, and such medications will be clearly labeled.
This child takes medication but we would prefer that an Adult Leader dispense medications. I understand that the adult to whom my child surrenders the medication may not have medical training. At the conclusion of the event it will be this child’s responsibility to pick up remaining medication(s), if any.
"Over the Counter" Medication Release: Check only one below
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.
I grant permission for the following nonprescription medication to be given to this child:
(medications, foods, plants, insects, etc.)
Any other special medical conditions of this youth that we should be aware of?
Parent(s)/Guardian(s) Information
Parent/Guardian/Conservator
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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