YOUTH TRACK REGISTRATION This form is for youth & their chaperones.
To register for the YOUTH track, please take the time to fill out the information below. This form must be filled out for all participants, SIGNED by their parents/guardian, & all CHAPERONES need to also fill out and purchase a ticket as well.
$45 per person by 2/9/2020 $55 per person after 2/9/2020 There must be one adult chaperone, age 21 and over, for every one to seven youth under the age of 18. Chaperones must arrive with, attend and stay with their youth during the Retreat in the same facility. All chaperones and volunteers must fulfill and be in compliance with their Diocesan policies and requirements for providing a safe and secure environment for minors. Youth Are you an adult 21 or over & Chaperoning youth? yes (PLEASE list the youth below you will be chaperoning) no more than 7 per person No (please list chaperone below)
RELEASE OF ALL CLAIMS
Name of Activity: Wyoming Catholic Youth Retreat
Location: St. Anthony Tri-Parish School 1145 W. 20th St. Casper, WY 82601
Contact Telephone Number (Gerise Vignaroli): 307.258.3221
Date of Activity: February 14, 15, & 16, 2020
If a participant is under 18, a parent or legal guardian must sign and participant must attend the Retreat with their own chaperone (one adult chaperone for every 1 to 7 young people in your youth group).
NOTE: ANY PARTICIPANT UNDER 18 YEARS OF AGE MUST HAVE A WRITTEN PERMISSION SIGNED BY A PARENT OR LEGAL GUARDIAN TO LEAVE THE RETREAT DURING RETREAT HOURS.
Signature of Legal Guardian of Participant By typing & signing my name below, I understand I am agreeing to the above legalities for all participants listed. The undersigned do hereby release, forever discharge and agree to hold harmless Wyoming Catholic Youth Retreat, participating parishes and their adult chaperones, and St. Anthony Tri-Parish Catholic School from and against any and all liability, claims, demands, lawsuits and expenses of any kind arising from personal injury, sickness, death or property damage of any kind whatsoever which may be incurred or suffered by the undersigned and/or participant. The undersigned further agree to indemnify and hold Wyoming Catholic Youth Retreat, participating parishes and their adult chaperones and St. Anthony Tri-Parish Catholic School and its respective members, directors, employees, and agents (collectively, the “Indemnities,”) harmless from and against any and all claims, demands, actions, lawsuits, and liabilities, including attorney fees and expenses and costs sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant. If participant is under 18 years of age, I (we) the parent(s) or legal guardian(s) of the participant, do hereby grant permission for your child to participate fully in the Wyoming Catholic Youth Retreat and all of its activities and hereby give permission to Wyoming Catholic Youth Retreat, participating parishes and their adult chaperones to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. Additional physical signature may be required at the time of the event.
Signature of Chaperone Participant By typing & signing my name below, I understand I am agreeing to the above legalities . Additional physical signature may be required at the time of the event. Please list any Allergy or Health concerns we should be aware of Submit