Higher Ground Registration

This form will need to be completed by both participant and parent.

NOTE: Week 1 is full. If you are unable to attend Week 2, please add your name to the Week 1 waitlist, and we will contact you if a spot becomes available.

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.  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 Katie Clark- Coordinator. 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 Conduct
To 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:

•          Be Respectful and Safe.  At Higher Ground, we expect to create an environment of safety and trust.  The use of our bodies, language, and humor must always honor the dignity of every person.  If you jeopardize the physical or emotional safety of yourself or the group, you choose to have a parent or guardian pick you up and take you home immediately.

•         Be Responsible and Honest.  Participants are expected to be present at all activities on time and participate fully.  Established guidelines will be observed at all times.  We need to take care of the building and grounds.  Any damage is to be reported immediately and involved persons are financially accountable.  Emergencies that involve the health and well-being of people and/or property must be reported to adult staff immediately.
•        The use of illegal drugs, including alcohol, or other illegal/harmful substances is not permitted.  If you use these materials, you choose to have a parent or guardian pick you up and take you home immediately.  Proper authorities will be notified.  Do not bring clothing that advertises/promotes alcohol, tobacco or drug use or anything displaying messages that are offensive or contain sexual innuendo.  These are contrary to the values of a Catholic youth camp and are not acceptable at Higher Ground.

•         Observe appropriate boundaries.  All participants must stay in designated areas.  Vehicles can only be used with specific permission from the director.  Males and females are lodged in dormitories with separate rooms.  Participants do not enter each other’s rooms unless supervised by an adult.  One of our goals is to relate with everyone present; therefore, during the week exclusive relationships are discouraged.  If you engage in activities contrary to these guidelines or any activities that jeopardize your safety or the safety of the group, you choose to be removed from the event.  Your parent or guardian will be called to pick you up and take you home immediately.

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. 

• All attire should be sized to fit without exposing undergarments, buttocks, stomachs or cleavage.
• Shirts must be long enough to naturally touch the top of the lower garment, with arms raised.  Shirts must cover the shoulders. No Spaghetti straps, tank tops, and halter tops or transparent/mesh clothing or shirts with revealing necklines or armholes. 
• Shorts and skirts must be fingertip length when arms are resting at sides. 
• No yoga pants or form-fitting pants/shorts. 
• No clothing or accessories that promote drugs, alcohol or tobacco either by brand or message. 
• No clothing or accessories with sexually suggestive language or messages or clothing or accessories that promote violence, criminal activity, intimidation or intolerance of others (based on religion, ethnicity, gender or lifestyle). 
• Modest swimsuit appropriate for a Catholic retreat setting, No Speedo or bikini.

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:

1. That I know and understand that this horse riding activity involves specific risks of property damage or personal injury to me or to my minor children arising from approaching, handling, mounting, riding, and dismounting the horse, irrespective of its training and usual past behavior and characteristics, may act or react unpredictably at times based on instinct or flight which likewise, is an inherent risk assumed by a horseback rider.
2. That I hereby release and forever discharge the State of Nebraska, its agents, and employees from all present and future claims arising from personal injury or property damage sustained by me or my minor children during the use of the horse, and I shall assume all risk related to horseback riding.
3. That I waive my right to file and promise not to file any legal proceedings against the State of Nebraska, its agents, or employees for any personal injury or property damage sustained by me or my minor children during this activity: and I shall pay all cost and attorney's fee from any legal proceeding which I may bring contrary to this agreement and which is resolved in favor of the State of Nebraska, its agents, or employees.
4. That I sign the Release Agreement for and in consideration of the agreed price, and I hereby request the State of Nebraska, its agents, or employees to choose for me and for my minor children a horse for the purpose of riding same, knowing that the State of Nebraska, its agents, or employees are relying upon this Release Agreement and the information, that have given them concerning my experience and that of my minor children with horses, including the potential hazards involved. 
5. That I have read the foregoing release and sign it freely with knowledge of its meaning and content.

THIS IS A LIABILITY RELEASE AGREEMENT

Please read carefully before signing

1. I accept for use as in the equipment listed on this form and accept full responsibility for the care of the equipment while it is in my possession.
2. I will be responsible for the replacement at full retail value of any equipment rented under this form, but not returned to Fort Robinson State Park rental office.
3. I agree to hold and indemnify Nebraska Game and Parks Commission, Fort Robinson State Park, Mountain Mania, agents, and employees, as well as the manufacturer and distributors of this equipment, for any loss or damage, including any that results from claims for personal injury, death or property damage related to the use of this equipment.
4. I agree to return all rented equipment by the agreed date in clean condition to avoid additional charges.
5. I understand that there are inherent and other risks involved in the activity of tubing and kayaking for which this equipment is to be used, that injuries are a common and ordinary occurrence of this activity, and I freely and voluntarily assume those risks.
6. I hereby release from any legal liability Nebraska Game and Parks Commission, Fort Robinson State Park, Mountain Mania, agents, and employees, as well as the manufacturers and distributers from any and all liability, negligence, breach of warranty, contract, claim or product defect, or other legal theory, accepting myself, the full responsibility for any and all such damages or injury which may result.
7. All instructions on the use of my rental equipment have been made clear to me, and I understand the functions of my equipment. 
8. I will be responsible for all on my own actions. If I am not following the designated rules and regulations of the park, I may be subject to punishment and fines.
   This agreement is non-negotiable.

I, {participantName}, have read and understand the rental and liability release agreement above.

Communications
Please 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

Please close your browser after you have submitted your registration in order to avoid unintentional duplicate submissions.