..:: Learning Stream ::..

All questions marked by an asterisk are required

Event Name:

Confirmation Retreat 2022-2023

Who: All Confirmation Students

When: February 10-12, 2023

Where: North Georgia Christian Camp | Clarkesville, GA - February

For your Child, please provide us with the following information:

*First Name:

*Last Name:

*Child's Preferred Name:

*Gender:

Male
Female

*Date of Birth:

*School Attending:

*Preferred Confirmation Retreat:

February 10 - 12, 2023 - North Georgia Christian Camp

*Street Address:

*City:

*State :

*Zip Code:

*Teen's TShirt Size (Adult sizes):

*Preferred Parent Email Address for Event Info:

*Retype Preferred Parent Email Address for Event Info:

EMERGENCY CONTACT /MEDICAL INSURANCE INFORMATION

Emergency Contact:

(Name of Relative/Friend to Contact if unable to reach parent/guardian in the event of an emergency)

Emergency Contact Phone Number:

Relationship of Emergency Contact:

Insurance Provider:

Insurance Policy Number:

Insurance Group Number:

Insurance Carrier:

(name of Parent/Guardian providing Insurance)

Insurance Carrier Address:

Insurance Phone Number:

Policy Holder:

(Name of Policy Holder as it appears on Insurance Card)

Allergies, Disabilities, or Special Needs:

Medications:

(if none, specify 'NONE')

PARENTAL PERMISSION

I give permission for my child(ren) to take part in CTK Young Church programs, including the following: EDGE, Life Teen, Confirmation, Empower, discipleship, socials, trips, retreats, etc. I understand that these activities will be supervised by adult chaperones with the child's safety being their first concern. I do further hereby release, absolve, indemnify and hold harmless the Cathedral of Christ the King, the organizers of the activity, sponsors, the supervisors and all of them. In case of injury to my son or daughter, I hereby waive all claims against the organizers or any of the supervisors appointed them. I likewise release from my responsibility any person transporting my child to and from any of the activities.

By inserting my Full Name in the following box and Checking the 'accept Electronic Signature Box below' I agree this constitutes my legal signature.

Parental Permission Slip: Parent/Guardian Signature:

MEDIA & COMMUNICATION RELEASE FORM

I hereby grant permission for my child(ren) to be photographed and/or interviewed for The Georgia Bulletin, or other media, including but not limited to television, radio, newspapers, and the internet, for public dissemination. I release and relieve CTK Parish, and the Archdiocese of Atlanta from any responsibility or liability for any claims arising from the publication or reproduction of any photographs or interviews in any news or other media. I waive any and all rights to inspect or approve the finished photographs or printed matter that may be used in conjunction with any photograph or to approve the eventual use for which it may be applied.

Understanding current communication through social media, texting, and messaging, I hereby grant permission for my child(ren) to opt into sending and receiving electronic communication from CTK Young Church staff and leaders. All CTK staff and leader have completed and passed a background check. I understand that I may request transcripts of any and all communication between my child(ren) and CTK staff and leaders at any time.

By inserting my Full Name in the following box and Checking the 'accept Electronic Signature Box below' I agree this constitutes my legal signature.

Media Release Form: Parent/Guardian Signature:

EMERGENCY CARE - PERMISSION

I give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events. I understand that any such instance, all attempts will be made to contact the parent/guardian. In the event that I cannot be contacted, I hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein.

MEDICAL & ONLINE SUBMISSION RELEASE: I/We, the parent(s)/guardian(s) of the above named candidate, do hereby give my/our permission and approval for my/our son/daughter/guardianship to participate In the CATHEDRAL OF CHRIST THE KING CONFIRMATION retreat, 2022/2023. I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone these events, other participants, (CATHEDRAL OF CHRIST THE KING), the Catholic Archdiocese of Atlanta, CTK Youth Ministry, and any of the above named parties’ representatives, successors, supervisors, sponsors, and/or organizers, for any injuries in connection with the outing / event(s) named above provided that said injuries are not the result of negligence. I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein. I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship. Furthermore, I/we agree that if the above named student’s behavior is inappropriate, unsafe and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility. I admit that all information submitted to the CTK Office of Youth Ministry through the Cathedral website(s) is accurate and may be used in the event of any emergency that may arise.

By inserting my Full Name in the following box and Checking the 'accept Electronic Signature Box below' I agree this constitutes my legal signature.

Emergency Care: Parent/Guardian Signature:

Accept Electronic Signature:

By checking this box and entering my name below, I agree that my name provided constitutes my legal signature for purposes of this registration.

Electronic Signature Name: