Valley Fair Registration

Valleyfair Trip- Saturday June 9th, 2018
Shakopee MN

We will be driving cars there.  Chaperones are needed.  The more chaperones we have, the more kids we can bring.  No one under the age of 21 will be driving a car.

We plan to leave Adrian at 8:00 AM and return to Adrian around 11:00 PM.  Additional locations for pick-up and drop-off may be available depending on chaperones. We plan to be at the park from 11:00 AM to 7:45 PM

No meals will be provided so please bring either a sack lunch for the morning or money for both lunch and supper at the park.

Cost is $20 per student except current mass servers whose cost is $5. Chaperones are free.

Pre-Registration is required.

Contact Information
Name
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Address
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Date of Birth //
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Age at time of event
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Grade Completed
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Parent/Guardian Name
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Relationship
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Main Phone --
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Cell Phone --
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E-mail
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Parental Consent/Liability Waiver/Medical Release
Consent I, _____________________, grant permission for _______________________ to participate in the above named activity and I warrant that my child is in good health and assume all responsibility for the health of my child. In consideration of my child’s participation, I agree on behalf of myself, my heirs, successors, and assigns, to hold harmless and defend above named parish and the Diocese of Winona, its officers, directors, employees and agents, chaperones, or representatives associated with the event, or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith; and any injury to my child from any cause or person whatsoever, any actions, claims, or demands that may arise because of my child’s actions or omissions resulting in injury or damage. I agree to compensate the above named parish and the Diocese of Winona 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 claims arises from the negligence of the above parish and Diocese of Winona in connection therewith.
Parent/Guardian Name
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Student Name
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Emergency Medical Treatment EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. I agree to pay the cost of medical treatment in connection therewith, and agree to compensate the parish and the Diocese of Winona for expenses incurred.
Parent/Guardian Name
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Medications taking at present
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Family Health Plan Carrier
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Policy Number
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Family Doctor
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Clinic
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Phone --
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Emergency Contact
Name
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Relationship
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Phone Number --
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Picture Release
Photographs The undersigned parent/guardian hereby consents that the Diocese of Winona/St. Adrian Cluster be permitted to use and publish for advertising, promotional, or publicity purposes, the photograph or video and internet site image of my child for lawful purpose and the undersigned parent/guardian does hereby release the Diocese of Winona/St. Adrian Cluster from any liability in connection with such use.
Name
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Date //
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Optional Medical Information
Optional Medical Information OPTIONAL MEDICAL INFORMATION: St. Adrian Cluster will take reasonable care to see that the following information will be held in confidence. o Allergic reactions (medications, foods, gluten intolerance, plants, insects) o Does your child have a medically prescribed diet? o Any physical limitations? o Is your child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bedwetting, or fainting? o You should also be aware of these special medical conditions of my child:
Answers to Optional Medical Information
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Non-Prescription Medications Optional: I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e.: acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed advisable
Name
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Date //
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Youth Code of Conduct
Remember Please remember that you are representatives of the St. Adrian Cluster. We expect you will represent your parish well during this event. Remember that you are a witness of Christ to others who will attend this gathering. We ask you to project an image of Christian charity and respect to everyone and the property around you. We are confident you will display maturity and responsibility in leadership and character. Thank you!
Code of Conduct Parish participants are responsible for their actions. Each participant accepts the full responsibility for any damage or theft caused while attending this event. Leaders/Chaperones are expected to enforce the Code of Conduct and set an example for the participants. 1. I will treat all persons as a son or daughter of God with dignity and respect. I will not intentionally cause any harm (physically, emotionally, or spiritually) to any person in any way. 2. I will respect the property of others, including all program facilities. 3. I will follow all appropriate instructions of all personnel aiding in this event, including, but not limited to, chaperones, support staff, transportation personnel, and administration. 4. I will be on time for all check-ins and departure times. 5. I will attend all activities and remain with my group at all times. 6. I will not bring, possess, or use illegal drugs. 7. I will not bring, possess, or use any tobacco products. 8. I will not bring, possess, or view morally inappropriate materials in any form. 9. I will not bring or possess any weapons. Possession of a weapon will mean immediate dismissal. 10. I will be aware of noise levels in sleeping areas. I will respect other’s need for sleep, quiet time, and privacy. 11. I will dress modestly at all times. 12. Men and women are to stay in separate sleeping areas and not visit the sleeping areas of the opposite sex at any time. Socializing may be done only in public areas.
Agreement I agree to abide by this code of conduct traveling to and from and during this event. I understand that failure to abide by this code may result in my being sent home at my own and/or parent/guardian’s expense.
Student Name
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Date //
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Parent/Guardian Name
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Date //
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For Your Information
Additional Information Valleyfair Information If you plan to go to the Soak City Waterpark, you must bring a bathing suit. For modesty purposes the following stipulations apply: Ladies- no bikinis unless covered by shorts and a t-shirt. One piece suits with shorts preferred. Two piece suits- the bottoms must either have a skirt attached or be covered with shorts. The top must cover the midriff area (no bellybuttons) or else you will be asked to wear a t-shirt over top. Guys- a t-shirt must be worn with your swim trunks. Please leave the Soak City area by 7:00 PM to allow your clothes time to dry before the car ride home or else bring a dry change of clothes along. We are allowed to go to the parking lot as long as we have a ticket and a stamped hand. (A chaperone must accompany any students who leave the grounds for any reason.) Shoes or sandals with straps are required for most rides. Flip flops are not a good choice for going on rides in the main part of the park. One bottle of factory sealed water per person may be brought into the park. Water is available at the food stands. We encourage you to stay hydrated throughout the day. We do not want to have to find you in the first aid tent. It is recommended that you travel light. Backpacks, purses, and other unsecured items are not allowed on most rides. A bystander may hold onto your belongings for you or lockers may be rented at the park for a price. You will be outside all day. Please wear sunscreen and reapply it. We will have periodic check-ins either by phone or in person throughout the day. For questions or emergencies please contact: Shannon Reker 507-329-0392