Liability Waiver: As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).
I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Philip Church, its officers, directors, employees and agents, and the Diocese of Nashville, its employees and agents, chaperons, or representatives associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Nashville, its employees and agents and chaperons, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/diocese.

Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Non-Prescription Medication: I grant permission to the adult staff/volunteers to give my child non-prescription medications such as cough drops, antacids, ibuprofen (Advil), etc. Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. Please list any pertinent medical information below (i.e. allergies, medications, medical conditions...)

The retreat cost is $75 by credit card, cash or check. If you cannot pay the full amount, please complete the form and submit, then contact Helen or Julianne about financial assistance. If you can afford to pay a little extra to help those who can't pay the full amount, please add your contributions to your check when you turn it in.