2025 Spring Retreat Adult Registration

Please select any food allergies your child has and describe their severity below:

Please list any other food allergies and their severity below:
Below is a question about our Annual Emergency Medical Care Forms.

Note: If you volunteered on the St. Charles fall high school retreat, we already have this information on file, and you can select "Yes". If you are uncertain, please contact Anna Laisure at alaisure@scbfw.org.
Have you completed an Annual Emergency Medical Care Form in the 2024-2025 academic year or since July 1, 2024?*

YesNo

Annual Emergency Medical Care Form
Emergency Contact Information
Emergency Contact 1 Name*

First NameLast Name
Emergency Contact 1 Phone Number*
Please enter a valid phone number.
Emergency Contact 2 Name*

First NameLast Name
Emergency Contact 2 Phone Number*
Please enter a valid phone number.
Consent to Emergency Medical Care
I understand that in an emergency, exigent circumstances may prevent the parish from contacting the above listed emergency contacts immediately, or the parish may be unable to reach them. I therefore consent to the parish taking action which it deems necessary to secure emergency medical care/treatment. I understand that decisions concerning the type of emergency medical care or treatment administered are normally made by health care providers and not by the parish and that exigent circumstances may require the administration of emergency medical care or treatment without my prior consent. However, I have indicated below any treatment preferences I have which the parish may disclose to a health care provider. Participants may complete any of the following:
Preferred Physician
Preferred Dentist
Preferred Hospital
The parish may disclose the following information to a health care provider:

Insurance Company Name: Insurance Company Name

Policy/Group/Claim No.: Policy/Group/Claim No.
Other Medical Facts (ex. allergies, medications)
Signature*

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Final Instructions and Signature
Thank you for registering as an adult chaperone for our retreat. There is one final step after this in order to be fully registered. After you provide a signature below, you will automatically be redirected to sign a waiver for St. Felix. This is a required form that you must complete. After you have completed the waiver, you will be fully registered for our retreat.

Thank you so much for offering your time to be with our young people!
Please provide your signature below to finish this portion of the registration process.
Signature*

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General Information