Participant's Information

Participant's Social Media Links

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by THE GOOD LISTENER during the selected Retreat. In exchange for the acceptance of said child’s candidacy by THE GOOD LISTENER, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless THE GOOD LISTENER and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected retreat/camp sessions.

Unless the single room rate is selected, every participant will share a room with up to 3 other participants and a chaperon for the Teen Retreats. For the Adult Retreats, you can expect to share a room with 2 other participants.

In being a participant, you agree to have your picture used for advertising and fundraising purposes by THE GOOD LISTENER.

In case of injury to said child, I hereby waive all claims against THE GOOD LISTENER  including all Directors, Coaches, Team Parents and affiliates, all participants, sponsoring agencies, advertisers; and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all outdoor or adventure activities. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the above named child, or an Adult, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to THE GOOD LISTENER and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.