High Adventure 2022 - Registration and Permission

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Registration and Parental Consent Form for Young Women High Adventure - to be held at Caddo Lake State Park, June 2 - June 4, 2022.

Ward *

Participant First Name *

Participant Last Name *

Street Address *

City *

State *

Zip *

Participant Birth Date *

YYYY

Participant Cell Phone *

Home Phone

Parent/Guardian Name (First and Last) **not required if registering as adult leader**

Parent/Guardian Cell Phone **not required if registering as adult leader**

Parent/Guardian Email **not required if registering as adult leader**

Additional Parent/Guardian Cell Phone

Additional Parent/Guardian Email

Doctor Name *

Doctor Phone Number *

Date of Last Tetanus Booster *

YYYY

Please Identify Any of the Following Medical Issues *

Asthma

Diabetes

Chronic/Recurring Illness

Epilepsy

Hypoglycemia

Physical Conditions that Limit Activity

Surgery or Serious Illness in the Last Year

None

Required

Do you have any Special Dietary Restrictions or Allergies to Food, Drugs, Plants or Insects? *

Do you have Regular Medications that must be taken during High Adventure? If so, please list details below (leave blank if none)

Which of the following medications may be given during high adventure (under the direction of the camp nurse)? *

Any Medications Listed Below

Acetaminophen (Tylenol)

Ibuprofen (Motril/Advil)

Antihistamines

Throat Lozenges

Cough Syrup

Decongestant

Anti-Diarrhea

Antacid

Naproxen (Aleve)

None of the Above

Required

Name of Insured

Insurance Numbers (Policy, Group, or ID)

Insurance Carrier

Insurance Phone Number

While at High Adventure, I would like to.... *

Sleep in a one man tent by myself

Sleep in a small tent with two or more other young woman

Participant's tent mates are.... (please plan ahead, all girls must list each others names and be approved by your parents)

Code of Conduct

As a participant at High Adventure, I agree to the following:

- I will show respect for the property of the camp facility as well as the property of all other camp participants
- I agree to be respectful in my demeanor, language and actions toward adult leaders and all other young women.
- Staying up all night (pulling an all-nighter) will no longer be allowed at camp for ANY levels. I agree to follow this rule, and I will go to sleep at the time indicated on my schedule.
- I recognize that High Adventure is a place to develop a testimony of Jesus Christ, build friendships and learn leadership skills. It is not a place to foster and develop physical relationships. Any flirting or romantic physical touch is not appropriate.
- I agree to follow the guidelines found in Standards For Youth in my dress, behavior, and language while participating in all activities at High Adventure. "When you are well groomed and modestly dressed, you invite the companionship of the Spirit and you can be a good influence on others" - SFY
- I agree to participate in all the activities to the best of my ability.
- I agree to pair off in groups of three or more if I ever need to leave the larger group
- As a youth participant, I agree to leave my cell phone and electronic devices at home while at High Adventure

I understand that a violation of any of the agreements may result in a loss of camp participation.

Signature of High Adventure Participant (Please enter your full legal name below as consent) *

Date *

YYYY

Parental Consent

I give my permission for my child to participate in the Young Women High Adventure. In case of medical emergency, I
understand that every effort will be made to contact parents or guardians. In the event that a parent or
guardian cannot be reached, I hereby authorize the adult leaders supervising this activity to administer
emergency treatment to the above-named participant for any accident or illness, and to act in my stead in
approving necessary medical care. This authorization shall cover this activity and travel to and from this
activity. I hereby agree to release the Carrollton Stake and Ward Leaders from any and all claims for liability
arising from participation in this activity and program, including any liabilities from coronavirus, and hold the Stake and Wards harmless from all expenses, costs, and claims in connection with any injury.

Signature of Parent/Guardian (Please enter your full legal name below as consent) *

Date *

YYYY

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