TEEN Nativity Retreat Lock-In

Name of Participating TEEN

Name of Participating TEEN 2

Name of parent/guardian

This address will receive a confirmation email

Phone of parent/guardian

Address

Secondary emergency contact name and phone number

Known Allergies

Any health concerns/ diagnoses to be aware of?

Any Food restrictions or preferences?

List all medications including: 1. Name of medication 2. Reason for taking 3. Dosage: Amount, when, how

My child can self-carry and self-administer Yes No

Any other concerns or comments you'd like to disclose to the leadership team?

Medical and Emergency Release and waiver

I swear or affirm that I am the parent or legan guardian of the following child(ren):

As the parent or legal guardian, I have the authority to enter into this Waiver and Release on my child(ren)’s behalf. I hereby release St. Spyridon Orthodox Church (“St. Spyridon”) from any and all liability or claims which may arise while my child(ren) participate in activities at the Nativity Lock In on the premises of St. Spyridon Orthodox Church. I understand and acknowledge that this release discharges St. Spyridon from any liability or claim that I may have against St. Spyridon and its employees, agents, officials, and volunteers, with respect to any injury or illness that my child(ren) may sustain, as well as any damage to mine or my child(ren)’s property, or any other claim that may arise from my child(ren)’s participation in this retreat. Please indicate your agreement by typing your full legal name below.

Medical Treatment: I hereby release and discharge St. Spyridon and its employees, agents, officials, and volunteers, from any claim whatsoever which arises from any first-aid treatment or other medical services rendered in connection with any urgent or emergency medical situation while my child(ren) are participants at the Nativity Lock-In. I also agree to allow distribution of any over the counter medications sent with my child to be administered as deemed necessary. Please indicate your agreement by typing your full legal name below.

Photographic/Video Release: I grant permission to St. Spyridon to use any and all photographs, videos, or audio recordings of my child(ren) attending the Nativity Lock-In for the purposes of advertising, promotion, and/or curriculum publication. Please indicate if you agree, or if you would like to opt out of this release for your child(ren) by checking the appropriate box below *

I agree I do not agree

Description

2023 TEEN Nativity Lock-In

Friday, December 15
6:00pm Akathist of Thanksgiving
6:45pm Cookies and Carols with the Parish
8:00pm TEEN Retreat Begins- Questions Session with Fr. Evan
Followed by games, mixers, snacks and fun, then evening prayers.

Saturday, December 16
8:00am Brunch and Q&A with Fr. Seraphim

All TEENS are then invited to the rest of the Adult Retreat, or MS students can instead register for the Youth Enrichment Retreat. The Nativity Retreat (including Youth Enrichment) on 12/15-17 Registration Form is: https://stspyridonchurch.breezechms.com/form/d7b3e8

TEEN Nativity Retreat Lock-In

Description

Please Fix the Following