This form will need to be completed by both participant and parent.
Please read before beginning this registration form.
If completing this application on a cell phone, please close the browser when done to prevent the application from being submitted more than once. Also, before completing this registration, please check with your parish for possible discounts they may be providing. Thank you
Parent(s)/Guardian: Please note that all communication relating to diocesan youth events is through the email you provided.
I/We, as the parents/legal guardian of the above-named participant, a minor, hereby grant the Diocese of Grand Island, their staff, and volunteers permission to transport this minor to an emergency medical or health care facility for immediate treatment and/or consultation, if deemed necessary. I/We understand that I/we will be notified of any emergency situation immediately. I/We give authorization to the attending physician, dentist, or medical personnel for any required immediate treatment in the event that I/we cannot be reached at the time of the emergency. I/We agree to be financially responsible for any and all medical expenses and/or treatment costs and all related services provided to the above mentioned minor, and I/We release the Diocese of Grand Island, their staff, and volunteers from any liability.
I/We understand that this event is sponsored by the Diocese of Grand Island. I/We hereby grant permission for My/Our son/daughter to participate in Higher Ground Retreats™and accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff/volunteers) taken by My/Our son/daughter, and I/We agree to hold the Diocese of Grand Island, their staff, and volunteers harmless with respect to any actions or claims that may be made in connection with personal actions taken by My/Our son/daughter. I/We also grant permission for the Diocese of Grand Island, their staff, and volunteers to use photos and videos of My/Our son/daughter for publicity/marketing purposes.
I/We authorize the release of information to My/Our insurance company and family physician:
Higher Ground Retreats™ are a five-day Catholic youth program. This program is sponsored by the Diocese of Grand Island, Office of Youth and Young Adult Ministry with Eric Heckman as Diocesan Director. The purpose of Higher Ground Retreats™ is to create an environment where Christian community may be experienced. The activities provide an enjoyable opportunity for young people to develop a better sense of self, to build positive relationships with others and to grow closer to God.
Code of ConductTo accomplish the purpose of Higher Ground Retreats™, everyone on the week must agree to a “Code of Conduct.” These guidelines are necessary to make the stay enjoyable for all and to avoid problems. Participants have a responsibility to themselves and others to follow these guidelines:
Dress Code In order to promote a safe, healthy and positive community experience the following dress code must be followed by all male and female participants and adult leaders. Clothing should be modest and appropriate to a youth retreat/conference setting. Clothing should not present messages contrary to the values of a Catholic youth program.
Parent / Participant Signature:
I/We understand and accept the guidelines and policies stated in this Code of Conduct. I will accept the consequences should my son/daughter choose to violate the code. I agree to come to the retreat and pick up my son/daughter, should he/she choose to behave in a manner that the director and staff judge to be a serious violation of this code and is contrary to the mission of Higher Ground.
By signing my name at the bottom of the Release, I agree that, for and in consideration of the opportunity to ride a horse provided by this state park, I agree to pay for such ride and further agree as follows:
THIS IS A LIABILITY RELEASE AGREEMENT
Please read carefully before signing
I, {participantName}, have read and understand the rental and liability release agreement above.
CommunicationsPlease note that all communications relating to diocesan youth events are through email. You will receive a confirmation email upon registration, if you do not find it in your inbox immediately, please check your junk file. If the confirmation email is not received, please contact us.
Additional communications relating to this camp will be sent approximately 3 weeks prior to the start of the camp. Please check your email and junk mail regularly for these communications.
NOTE: if you have an extra box at the end of the payment section, enter your billing zip code