ECyD Girls' Registration

- ECYD

Register here for the ECYD girls' events listed on the form below.
Go to https://www.campriverridge.org/ to register for Camp River Ridge Events.
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- Select Event REQUIRED
  Please select the camp / retreat you are registering for
  Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Participant's Birth Date (Month - Day - Year) REQUIRED Please fill out this field. Please enter valid data.
- Parish/School REQUIRED Please fill out this field. Please enter valid data.
- Participant's Email REQUIRED Please fill out this field. Please enter valid data.
- Participant's Grade REQUIRED Please fill out this field. Please enter valid data.
- Child's Allergies or Medical Issues
- Participant's Blood Type REQUIRED Please fill out this field. Please enter valid data.
- Nature & Duration of Activities REQUIRED Please fill out this field. Please enter valid data.
- 1. Activity Supervisors
  Consecrated women of Regnum Christi, Mom chaperones, college age volunteers.
- 2. Transporation
  Participant's are responsible for securing their own rides to the Holy Spirit Center or River Ridge.
- 3. Mentoring
  Participant's may be offered mentoring, which is intended to help young people personalize the princicples of Christian living that they receive at home and in club activities. Mentoring involves a private conversation with an adult in plain view of others. When dealing with adolescents, confidentiality will be maintained to foster openess of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to appropriate authority and to the parents (except in the those cases where the parent may be the alleged abuser).
- 4. Requirements
  The child names above is in good health and has no physical or medical limitations that would cause the activities as described above to be determined or dangerous to the child. Parents/guardians should specifiy allergies and medical issues in the section above.
- 5. Consent
  I/We hereby consent to the above-named child’s participation in the activities described above including mentoring, and specifically request that he be allowed to participate in those activities. I/We warrant that I/We have fill authority to legally consent to her participation in the activities described on this form, and all provisions contained therein.
- 6. Insurance
  I/We understand that RC activities does not carry any insurance relative to the activities or for any injury that may occur to the above named child is (a) covered by insurance through my own insurance carrier; or (b) I/We are personally financially responsible for any and all medical costs incurred as a result of the child's injury.
- 7. Emergencies
  If the above named child requires any medical treatments or procedures during the activities, I hereby consent to and authorize the above named activity supervisor(s) to make any decision and take action to arrange for such procedures or treatments in the discretionof the activity supervisor(s).
- 8. Release & Indemnification
  I/We release and waive, and further agree to indemnify, hold harmless or reimburse RC Activities, Inc and Consolidated Catholic Administrative Services, Inc., the individual members, agents, directors, officers, employees, volunteers, and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm, or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses (including attorney’s fees incurred by RC Activities, Inc. and Consolidated Catholic Administrative Services, Inc., or any of its individual employees, agents, volunteers, etc. in enforcing this indemnity provision) without limitation in time or amount, damdages or injuries arising out of, during in in connection with my/ our child’s participation in the activities, the travel to and there from, and the rendering of emergency medical procedures or treatment, if any. I/We understand that this release and indemnification shall survive the end of my/our child’s participation in the activities referenced in this form and shall have no limitation in time or amount.
- Parent/Guardian Full Name (First & Last) REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Country REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- 9. Emergency Contacts
  if, in the event or other medical emergency, I am unable to be reached by the telephone at my home or work telephone numbers listed below, I authorize the activity supervisor(s) to attempt to contact me through the emergency contacts listed below.
- 10. Authorization of all Images & Photography
  I/We hereby authorize RC Activities, Inc. to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by RC Activities, Inc. in its promotional materials and for its promotional purposes associated with its nonprofit activities. The authorization shall extend to use of my/our child’s image and likeness on the website of RC Activities, Inc., or its successor in operation or affiliated organizations upon written consent of RC Activities, Inc. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.
- I, the parent/guardian, hereby attest that I have carefully read this and give permission to participate, understand its contents, and agree to its terms and conditions.
  I Agree Please select this field.
- Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Signature Date REQUIRED Please fill out this field. Please enter a date.
- Are you interested in volunteering as a chaperone? (Must be Virtus Trained) REQUIRED Yes No Please fill out this field.
Submit