Covenant & Consent Form (for PARENTS and YOUTH - 2024)

Covenant and consent for retreat, release waiver and indemnification forms

2024 High School Quest - The Next Chapter

To be completed by PARENTS and YOUTH. Please complete the forms by October 20 and prior to coming to Cathedral Ridge.
MM slash DD slash YYYY
Grade as of Fall 2024
Youth Participant's Preferred Pronouns
Address

Photo Waiver - I give permission to use my child's image in the following formats:

Youthโ€™s names will not be listed or captioned with their photo on any public site. Please donโ€™t hesitate to be specific; we fully understand that while some families arenโ€™t worried about their childrenโ€™s photos being โ€˜out there,โ€™ for others it is a serious concern and possible safety issue. We want to honor your preferences at all times.
In-house displays for participating parishes
On churches' individual FaceBook pages
On churches' public websites
On Diocesan materials including but not limited to the Colorado Episcopalian, the Diocesan website, the Cathedral Ridge website, and the Cathedral Ridge Facebook page and Instagram.

Emergency Contacts

Medical Information and Authorization

Does your youth take prescription medication on a regular basis?(Required)
List each medication and include the condition medicine is prescribed for, the dosing amount and instructions and date and time of last dose before leaving for this retreat (ex. Metformin for Diabetes 2, 1 tablet twice a day with breakfast and dinner. Last dose taken today at breakfast):
List each medication and include the condition medicine is prescribed for, the dosing amount and instructions and date and time of last dose before leaving for this retreat (ex. Metformin for Diabetes 2, 1 tablet twice a day with breakfast and dinner. Last dose taken today at breakfast):
List each medication and include the condition medicine is prescribed for, the dosing amount and instructions and date and time of last dose before leaving for this retreat (ex. Metformin for Diabetes 2, 1 tablet twice a day with breakfast and dinner. Last dose taken today at breakfast):
List each medication and include the condition medicine is prescribed for, the dosing amount and instructions and date and time of last dose before leaving for this retreat (ex. Metformin for Diabetes 2, 1 tablet twice a day with breakfast and dinner. Last dose taken today at breakfast):
List each medication and include the condition medicine is prescribed for, the dosing amount and instructions and date and time of last dose before leaving for this retreat (ex. Metformin for Diabetes 2, 1 tablet twice a day with breakfast and dinner. Last dose taken today at breakfast):
Does your youth take an over-the-counter medication on a regular basis?(Required)
If yes, what over-the-counter medicines:
(check all that are permitted)

Permission to give over-the-counter medicines:

**Youth will be reminded to use sunscreen and insect repellent but are ultimately responsible for the application of both. Severe sunburn can be cause for youth to be sent home as it is a medical condition with inherent risks.

Instructions about medications

All medications, either prescription or over the counter will be collected by your youth leader before you leave for the retreat. Please put your youthsโ€™ medications in a zip lock bag clearly marked with their name and give them to your youth leader before they leave. Upon arriving at Cathedral Ridge, all medications will be collected by our trip nurse and kept in a secure location. Each day youth will come to the nurse to take their medications. A log will be kept of all medication taken by the youth.

IF YOUR CHILD STARTS A NEW MEDICATION BETWEEN NOW AND THE RETREAT, PLEASE MAKE SURE WE KNOW ABOUT THE NEW MED, HOW AND WHEN TO DISPENSE IT, AND ANY POSSIBLE SIDE EFFECTS IT COULD CAUSE, THANKS!

Emergency Room or Urgent Care

In the event of an emergency, I understand that every effort will be made to contact me as soon as possible, and that efforts to contact me will continue even as care or treatment is administered. If needed, which is your preference: Urgent Care or Emergency Room. An effort will be made to meet this request if possible.
Please make a selection:

I hereby authorize the adult leader(s) named below to act as agent for me and to seek and consent to any medical, dental, or surgical evaluation and treatment deemed necessary by a licensed medical professional.

Insurance

Participant's Name
Include: Name of Company, Policy # Street Address, City/State?Zipcode, Name of Policyholder Group #

Please provide your youth leader with a photocopy of your insurance ID card.

Signature Page

Parent/Guardian 1 Name(Required)
MM slash DD slash YYYY
Parent/Guardian 2 Name
MM slash DD slash YYYY