2021 spring Retreat Youth Registration

Youth Participant Registration

Spring Youth Retreat April 2021
Camping option information

All youth are invited to join us on Friday night for a campout under the stars at Living River! Arrival time is at 7 pm. No supper will be served. Bring a tent to set up on the field, or a hammock to hang around Durham Chapel. If you would like to join us, but don't have access to a tent, let us know and we will find one for you!
Important COVID Information

Both the Presbytery of Sheppards & Lapsley and Living River will be complying with all applicable CDC, state and local guidelines for minimizing the spread of COVID virus. These include cleaning protocols by Living River, social distancing, mandatory masks, outside activities, hand sanitizing, individually packaged snacks & meals, group accountability and discouraging group transportation. All participants are expected to abide by the protocols. Failure to do so will result in participant being sent home.
General Information
Church *
If Other, what church will you be attending with
Youth Name *

First Name Last Name
Grade *
Youth Council

Yes No
Address *

Street Address

Street Address Line 2

City State

Zip Code
I plan to

Attend Saturday April 17 only - cost $20 Camp Friday night and attend Saturday April 17 - cost $30
I plan to

Bring my own tent or hammock Need a tent or hammock
Parent/guardian Name (Emergency Contact 1) *

First Name Last Name
Parent/guardian Cell Phone Number (Emergency contact 1) *

Area Code Phone Number
Parent/guardian email *
example@example.com
Church Youth Advisor/Chaperone *
Name
Advisor/Chaperone Email *
example@example.com
To be filled out by Parent/Guardian of Participant
List any DIETARY allergies/ restrictions *
If none, please enter none
I require a epipen *

Yes No
List any non-Dietary allergies (bee stings, etc) *
If none, please enter none
I require an inhaler *

Yes No
List any medical conditions leadership team should be aware of. *
If none, please enter none
Medical Authorization and Release *

Should my child sustain or incur any accident or illness while at the event, I hereby authorize the Director,the Health Care provider or chaperone to execute any and all documents in my behalf, including necessary releases, which might be required by a medical facility to perform emergency care. I do not give permission
Photo release and permission to contact *

I give permission for any photos or videos taken of my child during the event to be used by the Presbytery of Sheppards and Lapsley and/or Living River for use of the public relations of the program. I do not give permission
Accident Insurance Disclaimer *

I understand I am responsible for all incurred medical expenses while my child is a participant at Living River
Community Guidelines *

I understand I will receive an email with information about what items to bring or not to bring to the retreat as well as community expectations for the weekend. I understand my child is responsible for knowing and adhering to these and may be sent home if not in compliance.
Covid Waiver

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that the Presbytery of Sheppards & Lapsley and Living River has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Presbytery of Sheppards & Lapsley and Living River can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to staff and other participants and their families. I acknowledge that my youth must comply with all set procedures to reduce the spread while attending. I attest that my youth: * Is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * Has not traveled internationally within the last 14 days. * Has not traveled to a highly impacted area within the United States of America in the last 14 days. * Does not believe he/she has been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * Has not been diagnosed with Coronavirus/Covid-19 . * Is following all CDC recommended guidelines as much as possible and limiting his/her exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Presbytery of Sheppards & Lapsley and Living River harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property..
I have read the above waiver *

I accept this waiver I do not accept this waiver
Parent Signature *

Clear
Payment
Type payment -- Cost $20 for Saturday only or $30 for camping and Saturday *

Bill the church Pay by check - Payable to Presbytery of Sheppards & Lapsley Pay by credit card Bill Presbytery

Credit card Payment

Please check the box below: For Credit Card Payment Only

Saturday retreat only $ 20.00

Camping & Retreat $ 30.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Please submit your registration! See you at Living River.
Should be Empty:

Youth Participant Registration

Camping option information

Important COVID Information

General Information

To be filled out by Parent/Guardian of Participant

Covid Waiver

Payment

Credit card Payment

Please submit your registration! See you at Living River.