Luke 18 Registration Form 2023

Luke 18 Registration Form

Luke 18 weekend is April 28-30, 2023. Please carefully fill in the form below. It is a bit long, but it's for the safety of your teen! Thank you in advance!
Please note: Some signatures are for the teens to sign and some of them are for the parents to sign. Please make sure to fill them out correctly.
Are you a...*

Emergency Contact(s)
Parent Name*

First NameLast Name
Parent Email (this is the primary email I will use to keep in contact with you leading up to the retreat)*
example@example.com
Parent Phone Number (this is the primary number I will use to keep in contact with you leading up to the retreat)*

Area CodePhone Number
Parent Name

First NameLast Name
Parent Phone Number

Area CodePhone Number
Parent Email
example@example.com
To make this retreat happen , we need parents' help. Please check all the boxes you would be willing to help with. More information will be sent via email.*

Meals- volunteers are needed to set up/serve food at each mealSet up before the retreat and/or take down after the retreatAdoration hour- we need volunteers to help make the retreat a success through the power of prayer.I am unable to help with the above tasks

Medical
Any special dietary requirements, medical history, medication or major allergies? *
Physician*

First NameLast Name
Physician Phone Number*

Area CodePhone Number
Health Insurance Company*
Policy Number*
Do you grant permission to adult chaperones to give my child non-prescription drugs (Tylenol, etc.) in the event circumstances reasonably demonstrate that my child is in need of such drugs?*

I DOI DO NOT
I hereby authorize any adult chaperone to consent to any medical treatment of the named youth, which, in the judgment of recognized medical facility, under the general or special supervision of a licensed physician, may be deemed necessary.
Parent Signature*

Clear

Medication Prescription/Instruction

Policy for dispensing medication: If your son or daughter needs medication, please fill out the following parental permission/instruction. This is for all participants under the age of 18.
If your teen will be bringing medicine on the retreat, please choose one.

I give permission to authorized personnel to administer the following medication to my child during Luke 18 2023.I give my teen permission to administer the medicine to themselves during Luke 18 2023.
If you need an adult to help administer the medicine during the retreat, please put the medicine in a ziploc bag and label it with your teen's name, to be turned in when you arrive on Friday evening.
Medicine Name
Purpose of Medication
Time to be taken
Amount to be taken

Sleep Houses

One of the most fun parts of Luke 18 is the sleep houses! There will be 4-6 participants & two high schoolers in each group, and after programming on Friday and Saturday, groups will head to a house to sleep for the night. Sleep houses are a huge gift, because they are such a great time for teens to build community with each other and the high school leaders!
Sleephouses CANNOT happen without your help.

All you need is a space for 6-8 people to sleep (the floor is fine!)

Teens will provide their own bedding. We will provide snacks for teens to bring to the sleephouses each night and breakfast each morning, so you do not need to worry about food.

Can you help us out?!?
*

I can host a group at my house for FRIDAY NIGHT, APRIL 28th.I can host a group at my house for SATURDAY NIGHT, April 29th.I can host a group at my house BOTH NIGHTS, April 28th and 29th.I cannot host a group at my house.
Please list 1-3 teens your son/daughter would like to be in a sleep house with.
We will do our best to accommodate for preferences, but no promises!

I hereby authorize my son/daughter to attend Luke 18. I understand that Luke 18 participation requires a commitment to the full weekend experience and leaving for other activities is prohibited.

I understand that my son/daughter will be offered the opportunity to participate in various activities throughout the weekend. It is understood that all possible caution will be taken by those persons in charge to keep everyone safe and to prevent injuries, but neither chaperones, young adult leaders, teens, sleep house parishioners, employees, nor Assumption Parish will be held responsible in the case of an accident or injury.

I understand that if my teen behaves in a manner that is deemed inappropriate, is continually disruptive, or is found with illegal drugs or alcohol, I will be called immediately to pick up my child from the activity site.
Signature*

Clear
By signing this form, I acknowlege that my registration is not complete until I turn in the payment and fill out the media authorization (if not on file at the school), and I commit to paying it to secure my spot. It is non-refundable.

(High school volunteers- $50. 8th grade participants- $100.)

Make checks payable to Assumption Youth Ministry. There are scholarships available if this is a problem. Please do not hesitate to ask.
Should be Empty:

Luke 18 Registration Form