Junior Youth Retreat Step 1 of 250%Participant / Child's Name First Last Participant's Grade678Shirt Size*Extra SmallSmallMediumLargeExtra LargeAdult Sizes OnlySchoolContact Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Medical InformationHealth NumberFamily DoctorDoctor PhoneAllergiesIllnessesMedicationsDietary RestrictionsFull 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 AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code (if different from above)Parent / Guardian 1 Email Parent / Guardian 1 Phone*Parent / Guardian 2 Email Parent / Guardian 2 PhoneIn 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 AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Relationship to ChildThe 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 signingSignatureSecondary SignatureIf 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.