Life Teen Fall Retreat Form
Catholic Archdiocese of Atlanta
All Saints Catholic Church
Sep 29 - Oct 1st, 2017
Cost: $190
Deadline: Sep 17th, 2017
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  • PARENTAL CONSENT & Liability Wavier

  • I, (Parent/Guardian above), grant permission for my child, (Participant above), to participate in this parish event that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and /or volunteers from the parish. A brief description of the activity follows:

  • Type of Event: Life Teen Fall Retreat

    Sep 29 - Oct 1st, 2017
  • Destination of Event: Life Teen Camp Covecrest

    Tiger, Ga
  • Individuals in Charge:

    Jessica Duron & Jesse Butrum
  • Estimated time of Departure

    Departure: Fri. 6pm
    Meeting in front of the Youth Lounge
  • Estimated time of return

    Pickup: Sunday 6pm
    Meeting in front of the Parish Hall
  • Mode of transportation to and from event

    Charter Bus
  • As a parent and / or legal guardian, I remain legally responsible for any personal actions taken by my child. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend this All Saints Catholic Church, its officers, directors, and agents and the ARCHDIOCESE OF ATLANTA, Georgia, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Archdiocese of Atlanta, chaperones, or representatives associated with the event for reasonable attorney's fees and expenses arising in connection therewith.

    I / We hereby grant permission for publication of group (two or more persons) photo taken at youth events.
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  • EMERGENCY MEDICAL RELEASE

    Life Teen Fall Retreat (Sep 29 - Oct 1st, 2017)
  • I/ We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone this event, other participants, All Saints, the Catholic Archdiocese of Atlanta, All Saints Life Teen, All Saints EDGE, and any of the above named parties’ representatives, successors, supervisors, sponsors, and/or organizers, for any injuries in connection with the outing / event(s) named above provided that said injuries are not the result of negligence. I/We hereby grant permission for publication of group (two or more persons) photos taken at youth events.

    I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein.

    I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship.

    Furthermore, I/we agree that if the above named student’s behavior is inappropriate, unsafe and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility.
  • Insurance Information

  • EITHER A PHYSICIAN’S PRESCRIPTION OR PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS, PRESCRIPTION / NOTE SHOULD BE ATTACHED TO THIS FORM.
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  • Dosage
    Description
    Description
  • Requested information on this form MUST be filled in completely in order for the student to participate in these events.
  • Emergency Contact

    Relative or friend to contact if unable to reach parent/guardian in he event of emergency:
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  • In signing this form, I certify that all information contained herein is true and accurate to the best of my knowledge.

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  • In signing the above line, I agree to abide by any / all policies and rules established for this event / activity. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent’s expense.

    Basic rules / expectations include, but are not limited to, the following: Respect for all adult leaders, peers, and all property; NO illegal drugs, alcohol, underage smoking, firearms, explosives, or other illegal substances; Males and females are to remain in separate sleeping spaces at all times; No inappropriate physical / sexual activity; Appropriate attire is to be worn at all times. Other guidelines may be set forth accordingly by adult chaperones present for the event(s).
  • Payment Play Informations

    * All Checks should be made out to All Saints Catholic Church

    * If you pay with cash feel free to bring the cash to the event.

    *Office Hours: M-F 9AM - 3PM