Retreat Registration

Junior Youth Retreat

Step 1 of 2

Participant / Child's Name
First Last
Participant's Grade
Shirt Size*
Adult Sizes Only
School
Contact Address
Street Address Address Line 2 City Province Postal Code
Medical Information
Health Number
Family Doctor
Doctor Phone
Allergies
Illnesses
Medications
Dietary Restrictions
Full Name(s) of Parent(s)/Guardian(s):
Parent / Guardian 1 Full Name*
First Last
Parent / Guardian 2 Full Name
First Last
Parent/Guardian Address
Street Address Address Line 2 City Province Postal Code
(if different from above)
Parent / Guardian 1 Email
Parent / Guardian 1 Phone*
Parent / Guardian 2 Email
Parent / Guardian 2 Phone
In the event that I/we are unavailable, I/we designate the following alternate contact(s) to speak for me/us:
Designate Name
First Last
Designate Email
Designate Phone*
Designate Address
Street Address Address Line 2 City Province Postal Code
Relationship to Child
The Roman Catholic Diocese of Saskatoon requires all employees and volunteers to abide by the enclosed Covenant of Care. We acknowledge and affirm that the parents are the primary educators of their children and encourage parents to educate their children according to their age and maturity about the Covenant of Care that their leaders will be following.
Saint Anne's Parish - Junior Youth Retreat at Holy Family Cathedral

I/we grant permission for the Child Named on this form to participate in the above event/activity and take responsibility for arranging for transportation to and from the event/activity.
In signing below, I/we hereby acknowledge that sufficient information has been provided by the event coordinators with respect to the planned activities, duration, location, method of transportation, sleeping arrangements, participants and supervision. I understand that I am welcome to attend or drop in at any time during the event/activity.
I/we understand that parents/guardians of all children are responsible for transportation to and from events, unless shared transportation details have been provided. Youth with licenses will drive themselves/others only with my/our approval. No employee or volunteer working within or on behalf of the Roman Catholic Diocese of Saskatoon will ever ask or give consent for a youth with a driver’s license to drive another child or youth.
Consent
I agree.
I/we have provided the following medications and give consent for them to be dispensed at the request/need of my/our child:
In the event that I/we are unavailable, I/we do hereby give consent for all emergency medical care (including surgery, if deemed necessary and recommended by at least two attending physicians) prescribed by a duly licensed physician for my child in the event of injury or illness during the above-named event/activity. This emergency medical care may be given under whatever conditions are deemed necessary, so as to preserve and protect life, limb, health and well-being of my child.
I/we assume all risks and hazards incidental to or attendant with my child’s participation in the above-named event/activity, and in each phase of it.
Name of Parent/Guardian signing
Signature
Secondary Signature
If a second signature is required by a joint-custody or other legal agreement, please fill out below:
Name of Second Parent Guardian Signing
First Last
Date
Date Format: MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Junior Youth Retreat

Step 1 of 2

Medical Information

Full Name(s) of Parent(s)/Guardian(s):

In the event that I/we are unavailable, I/we designate the following alternate contact(s) to speak for me/us:

© 2020 Saint Anne's Parish

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Junior Youth Retreat

Step 1 of 2

Medical Information

Full Name(s) of Parent(s)/Guardian(s):

In the event that I/we are unavailable, I/we designate the following alternate contact(s) to speak for me/us:

© 2020 Saint Anne's Parish

Top ↑

Like us on Facebook  | Follow Us on Youtube  | 

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