Sophomore Retreat 2021 Permission Form for BCHS and Camp Allendale

  • This is to be filled out by parents/guardians only.
  • Info needed:  health insurance and physician information.
  • If you are not sure, find the day your student is assigned at THIS LINK
  • By submitting this form, you are completing the BCHS release form AND the Camp Allendale Liability Form. A 'Question Mark' by a field of info indicates that this information will be included on the Camp Allendale form.

Student Information

 +
Date of Retreat *

Medical Information

Does the student have any allergies, reactions to medications, any other medical limitations? *
Does the student have limiting physical disabilities or handicaps (temporary or permanent)? *
Is the student currently taking any medication (prescribed or otherwise)? *
Does the student have health/accident insurance? *

INSURANCE INFORMATION: (Both lines MUST be completed.)

Parent/Guardian Information

Relinquish of Claims against Bishop Chatard HS only

I recognize and acknowledge that there are risks in my child’s/ward’s presence and participation in the school sponsored program identified above. I agree to indemnify Bishop Chatard High School and it harmless, and I hereby waive and relinquish all claims, including any claims arising out of negligence that I may have against Bishop Chatard High School, its officers, agents, employees, representatives or volunteers arising out of any activity my child/ward participates in while attending the program or in connection with transportation to or from the program.
  I agree that my child shall abide by all Bishop Chatard rules and policies. I have reviewed and discussed the rules and policies with my child prior to signing this form. I agree that if my child fails to abide by the rules/policies, or engages in a serious infraction, he or she may be immediately dismissed from the school sponsored program above with no refund, and sent home at my expense
  I understand that my child may be photographed, unidentified in group situations; and I hereby grant permission for my child to be photographed & identified for releases to Bishop Chatard and the Bishop Chatard website and/or other promotions
Medical Release
  Our permission is hereby given to the school representative of Bishop Chatard High School to authorize, by his/her signature, whatever medical or surgical treatment may be considered necessary or advisable by the physician or nurse in attendance in the event of an accident or medical emergency involving my student.

Camp Allendale Release of Liability -- PLEASE READ THOROUGHLY

By filling in this online form, you will be completing the required 'Applicant Information and Release Liability' form for Allendale Camp as stated below. (View their form in entirety here).
 
Disclosure:  Camp Allendale’s “Challenge Activities” involve a variety of activities that often include warm-ups, group initiative problems, and both low and high ropes course elements. The level of participation in a Challenge Activity is at all times completely up to the individual’s choice. There is a risk, which must be assumed by each participant, that he or she may suffer an emotional or physical injury. Bruises and scratches are not uncommon.
Policy for participation in all Challenge Activities require that every participant have health/accident insurance coverage. In addition, certain health/medical information must be made available to Allendale. This information will be held in confidence. 
 
 
Release of Liability for Camp Allendale: I understand that parts of the “Challenge Activities” may be physically or emotionally demanding. I affirm that my student/ward's  health is good, and that he/she is not under a physician’s care for any undisclosed condition that bears upon  fitness to participate in the challenge activities. I recognize the inherent risk of injury in these programs. I understand that each participant must assume the risk of physical injury that could result from any of these activities. I release Camp Allendale and its staff members, and Board of Directors, from all liability for any injury to my child/ward from participation in challenge activities. 
Consent: *
 +
Secured by Formsite