GS High School Vacation

REGISTRATION

June 23-28, 2019
YMCA of the Rockies
Winter Park, CO

Cost: $450
You will be directed to a payment page after completing the following form.

Attendees are asked to be at Nativity by 1:30pm on Monday, June 23, for a 2:00pm departure. Transportation will be provided by bus. We will arrive again at Nativity on Friday, June 28 at 3:00pm.

Sex
Birthdate
Birthdate
Address *
Address
Home Phone
Home Phone
Parent/Guardian Cell Phone
Parent/Guardian Cell Phone
Participant Grade *
Participant is going into which grade in Fall 2019?
Participant T-shirt Size *
Adult Sizes Only
ACTIVITY RELEASE FOR MINOR PARTICIPANT
Information *
Media Release *
Movie Release *
NOTE: By typing your name in the signature field, you are signing this agreement electronically, which is as legally binding as a regular signature.
Today's Date *
Today's Date
MEDICAL MATTERS
Emergency Contact
Emergency Contact
If different than parent listed above.
Emergency Phone
Emergency Phone
If different than parent phone listed above.
Doctor Phone
Doctor Phone
Date of Last Tetanus
Date of Last Tetanus
Date of Last Flu Immunization
Date of Last Flu Immunization
The emergency contact should be contacted in the event it comes to the attention of the parish, its officers, directors and agents, chaperones, or representatives associated with the activity that Participant experiences symptoms such as headache, vomiting, sore throat, fever, diarrhea, etc. *
I/We hereby grant permission for the following non-prescription medication (non-aspirin products such as acetaminophen or ibuprofen, throat lozenges, cough syrup, etc.) to be administered to the participant if deemed appropriate.
NOTE: By typing your name in the signature field, you are signing this agreement electronically, which is as legally binding as a regular signature.
Today's Date *
Today's Date
ADDITIONAL INFORMATION
Include departure and return date, time, and locations.
Parent Chaperones *