Dear Parents/Guardians of Epiphany Middle School Students,

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Dear Parents/Guardians of Epiphany Middle School Students, My name is Carly Radke and I am the Middle School Youth Minister here at the Church of the Epiphany.

1 Dear Parents/Guardians of Epiphany Middle School Students, My name is Carly Radke and I am the Middle School Youth Minister here at the Church of the Epiphany. I have enjoyed getting to know your sons and daughters throughout this last year at Epiphany. I would like to invite your son/daughter(s) to come with me to Extreme Faith Camp (EFC) this summer from Monday, June 11 th to Friday, June 15 th. I am looking forward to this June when we will again bring Epiphany youth to join over 150 other middle school-aged youth for a week of fun, faith, and fellowship. Extreme Faith Camp is a Catholic summer camp for middle school aged-youth (current 6 th -8 th graders) started by a group of youth ministers in the Archdiocese of St. Paul/Minneapolis 17 years ago. As youth ministers, we already are hard at work to prepare for camp and are excited for the great week ahead of us! At EFC, there is always at least one priest on site. We have Mass every day, Adoration, praise and worship, Confession, small group time, and themed large group talks. Our theme this summer is The Battle Belongs to the Lord! (1 Samuel 17:47) Located at Big Sandy Camp in McGregor, MN, there is so much to do: swimming, archery, Crazy Olympics, petting zoo, crafts, mountain bikes, laser tag etc. We encounter Christ through the power of the Sacraments, challenging talks, and small group sharing. Youth are constantly moving and learning, making deep friendships that are founded on faith and active participation. The facilities are ideal for a safe environment for youth and adults with an on-site nurse, adult chaperones, youth ministers, and teen leaders. The cost of this event is $425. This cost includes a week of fun, meals, housing, transportation, T-shirt, crafts, and water bottle. There is one fundraising opportunity available in the spring, the weekend of April 28 th and 29 th at the Masses. See the attached fundraising page for more details. Please complete the following registration form completely and turn into the parish or school office with a $100 down payment by April 20 th. Space is limited and spots will be filled in the order registration forms are turned in. Late forms will be accepted until April 27 th with a $15 late fee. No forms will be accepted after April 27 th. If you have any questions or concerns, please contact me at or cradke@epiphanymn.org. In Christ, Carly Radke, Middle School Youth Minister

3 Extreme Faith Camp 2018 Middle School Permission Form Church of the Epiphany PARENTAL/GUARDIAN CONSENT AND INDEMNITY AGREEMENT Participant s Name: Home Address: City: State/Zip: Home Phone: Date of Birth: / / Gender: Male Female Grade in School (Fall 2018): Parent/Guardian s Name: Ph: Adult T-Shirt Size: SM MED LG XL XXL XXXL C: Parish: Church of the Epiphany Type/Date of Event: Extreme Faith Camp Monday, June 11 th - Friday, June 15th Location: Big Sandy Camp McGregor, MN Group Leader: Carly Radke (Middle School) and Eric Duffy (High School) Departure: Monday, June 11th Return: Friday, June 15 Mode of Transportation: Bus Cost of Event: $425 due by April 20 th. Late forms will be accepted until April 27 th with a $15 late fee. No forms will be accepted after April 27 th. $100 Down Payment REQUIRED for registration. I,, GIVE PERMISSION FOR Parent or Guardian Name Child Name TO PARTICIPATE IN THE ABOVE-DESCRIBED EVENT and I warrant that my child is in good health. In consideration of my child s participation, I agree to indemnify the Church of the Epiphany and the Archdiocese of St. Paul and Minneapolis from any claims or law suits brought against the Church of the Epiphany and the Archdiocese of St. Paul and Minneapolis by myself, my child, or others that arises out of any behavior by my child at the event described above. I also agree to pay reasonable attorney s fees or expenses incurred by the Church of the Epiphany and the Archdiocese of St. Paul and Minneapolis in defense of such a claim/suit. I agree to drop my child off at the departure location at least 15 minutes prior to departure and to provide transportation home at my expense. I agree that I am responsible for my child s conduct and actions. The event sponsor is not responsible for any injury or damage incurred or caused by my child. I understand that my child is required to comply with the Code of Conduct provided by the Church of the Epiphany while participating in the event. I understand that if my child violates the Code of Conduct he/she may be required to be transported home at my expense. Parent/Guardian Signature Date EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. I agree to allow my child to receive emergency medical treatment at my expense at the discretion of the event sponsors. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of any emergency, if you are unable to reach me at the above numbers, contact: Emergency Contact Name Relationship Phone Number (best number)

Church of the Epiphany Parish & School DISCLOSURE, AUTHORIZATION, CONSENT AND RELEASE FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS I am the parent or legal guardian of (full

4 Church of the Epiphany Parish & School DISCLOSURE, AUTHORIZATION, CONSENT AND RELEASE FOR SOCIAL MEDIA OR OTHER ELECTRONIC COMMUNICATION INVOLVING MINORS I am the parent or legal guardian of (full name of minor) ( My Child ). AUTHORIZATION, CONSENT AND RELEASE FOR USE OF VISUAL LIKENESSES AND ORIGINAL WORKS OF MINORS I authorize and consent that Church of the Epiphany Parish & School and the Archdiocese of Saint Paul and Minneapolis be permitted to use and publish for general communications, advertising, commercial or publicity purposes, or for any other lawful purpose whatsoever the likeness of My Child and My Child s original work, including video, photographic portraits, pictures, or reproductions, made through any medium, including social or other electronic media, in accordance with the Acceptable Use Policy for Electronic Communications and the Social Media Policy, provided only the first name (not the family name) is identified if any name is used. I hereby release Church of the Epiphany Parish & School, the Archdiocese of Saint Paul and Minneapolis, and anyone authorized by Church of the Epiphany Parish & School or Archdiocese of Saint Paul and Minneapolis with such use. This consent regarding My Child s likeness or original work is valid for one year. If I choose to rescind my authorization and consent, I agree that I will inform Church of the Epiphany Parish & School in writing and that my rescission will not take effect until it is received by Church of the Epiphany Parish & School. I understand however that it may not be possible to recall any work or photos that have been published prior to receipt of my written rescission. I have read the above Disclosures, Authorizations, and Releases, have had the opportunity to consider their terms, and understand them. I execute this document voluntarily and with knowledge of its significance. Parent/Guardian Name (please print): Signature of Parent/Guardian: Date:

5 HEALTH INFORMATION: ***A copy of Your Medical Insurance Card must be attached to this form in order for it to be processed. Medication my child is taking at present For headache or minor pain, my child may be given Allergies Other Medical Conditions Insurance Company Family Health Plan carrier number Family Doctor Phone Number Parent/Guardian Signature Date 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. (Of the following statements pertaining to medical matters, sign only those that are applicable.) Medical Treatment: In the event it comes to the attention of the Church of the Epiphany, its officers, directors and agents, and the Archdiocese of Saint Paul & Minneapolis, chaperons, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called at my expense. Signature: Date: If your Child is taking Medications and will need to take these medication during the event: My child will bring all such medications necessary, and such medications will be in the originally marked bottles. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are indicated on attached Prescription Drug & Medical Authorization Form. Signature: Date: 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 appropriate. Signature: Date: Specific Medical Information: the Church of the Epiphany will take reasonable care to see that the following information will be held in confidence. Allergic reactions (medications, foods, plants, insects, etc.): Immunizations: Date of last tetanus/diphtheria immunization: Does child have a medically prescribed diet? Any physical limitations? Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.? If so, date and disease or condition: You should be aware of these special medical conditions of my child:

6 BIG SANDY YOUTH REGISTRATION / MEDICAL FORM Camper name M F Address City State Zip Home Phone # Address / /_ Grade Age at Camp Birth date Retreat/Camp Session Date Year Church Sponsoring, if any Parent or Guardian Emergency Contact Person Emergency Home Phone Emergency Cell Phone Health Insurance Company Insurance ID # Group # Physician s Name Phone Number HEALTH HISTORY CHECK (X) THOSE THAT APPLY EPILEPSY HEART TROUBLE CHICKEN POX SKIN TROUBLE ASTHMA BED WETTING CONVULSIONS EAR TROUBLE EMOTIONAL PROBLEMS ALLERGIC TO: PENICILLIN INSECT STINGS OTHER (LIST) IMMUNIZATION RECORD CHECK (X) IF IMMUNIZED AGAINST. POLIO SMALL POX DIPTHERIA WHOOPING COUGH MEASLES RUBELLA Date of Last Tetanus Booster LIST ANY ACYTIVITY RESTRICTIONS, DIETARY RESTRICTIONS, HEALTH PROBLEMS AND/OR MEDICATION (RX OR OTC) RELATING TO YOUR CHILD. PLEASE GIVE A DESCRIPTION OF ANY CURRENT PHYSICAL, MENTAL, OR PSYCHOLOGICAL CONDITIONS REQUIRING MEDICATION, TREATMENT, OR SPECIAL RESTRICTIONS OR CONSIDERATIONS WHILE AT CAMP. USE THE REVERSE SIDE OR AN ADDITIONAL SHEET. IMPORTANT IF THE HEALTH HISTORY IDENTIFIES HEALTH PROBLEMS OR ACTIVITY LIMITATIONS, A PHYSICAL EXAMINATION MUST BE PERFORMED BY A LICENSED PHYSICIAN WITHIN ONE YEAR BEFORE ADMISSION TO CAMP, INCLUDING INSTRUCTIONS RELATIVE TO THE LIMITATION OF THE CAMPER S PARTICIPATION IN CAMP ACTIVITIES OR MEDICATION REQUIREMENTS. I UNDERSTAND THAT EVERY EFFORT WILL BE MADE TO PROTECT AND SAFEGUARD ALL GUESTS. I AGREE NOT TO HOLD BIG SANDY CAMP LIABLE FOR ANY ILLNESS OR MISHAP FROM ANY CAUSE WHATSOEVER. I ALSO GIVE CAMP FULL AUTHORITY IN DEALING WITH CAMPER DISCIPLINE. I UNDERSTAND THAT ANY CAMPER DISREGARDING CAMP RULES IS SUBJECT TO BEING SENT HOME WITH NO REFUND OF CAMP FEES. I UNDERSTAND THAT ANY CAMPER WHO WILLFULLY DESTROYS PROPERTY WILL BE HELD RESPONSIBLE AND BE CHARGED ACCORDINGLY. BIG SANDY CAMP MAY USE PHOTOS, VIDEO, OR COMMENTS, OF THE CAMPER NAMED ABOVE IN ITS PROMOTIONAL MATERIALS. I GIVE PERMISSION TO BIG SANDY CAMP TO DISPENSE MEDICATION (RX OR OTC MEDICATION) TO MY CAMPER TO MANAGE ILLNESS AND INJURY AS DIRECTED BY THE BIG SANDY CAMP MEDICAL PROTOCOL. IN CASE OF EMERGENCY, IF I CANNOT BE CONTACTED, OR THE EMERGENCY NUMBER CANNOT BE CONTACTED, I HEREBY GIVE PERMISSION TO THE PHYISCIAN SELECTED BY THE CAMP DITRECTOR TO HOSPITALIZE, SECURE TREATMENT FOR AND TO ORDER INJECTION, ANESTHESIA OR SURGERY FOR MY CHILD, AS NAMED ABOVE. ALL ABOVE INFORMATION IS CORRECT AS LISTED. SIGNATURE OF PARENT OR GUARDIAN DATE

CODE OF CONDUCT The following are a few rules that all participants are expected to follow while participating and representing the Church of the Epiphany, in this event sponsored by the Church of

not cause any intentional harm (physically, emotionally, mentally, or spiritually) to any person in any way on this event respect the property of others, including all program facilities and property

7 CODE OF CONDUCT The following are a few rules that all participants are expected to follow while participating and representing the Church of the Epiphany, in this event sponsored by the Church of the Epiphany. Please read and sign. I,, Printed Name of Youth Participant WILL: treat all other persons with the respect and dignity that God has infused into each human person. not cause any intentional harm (physically, emotionally, mentally, or spiritually) to any person in any way on this event respect the property of others, including all program facilities and property follow all appropriate instructions of all personnel aiding in this event, including, but not limited to, parish leaders, chaperones, support staff, transportation personnel, Big Sandy Camp staff, and administration be on time for all check-ins and departure times throughout the entire event not have in my possession any tobacco, alcohol or any controlled illegal substance Dress Code for Girls: camper initial here Shirts: No cleavage, bare midriff, open backs, visible bra straps. No tank tops will be worn. Pants: You must be able to sit down or bend over without showing any part of your undergarments. No leggings, jeggings, yoga pants, or exercise tights. Tears in jeans must follow the rule for shorts Shorts: Hem must hit at least mid-thigh (see picture for reference). No running shorts. Please be conscious that shorts often ride up while walking and engaging in various physical activities. Bathing suits: Only one-piece, tankini, or two-piece with a shirt over the top will be permitted. Dress Code for Boys: camper initial here Shirts: must remain on unless swimming. Pants: must cover all undergarments at all times. No leggings. Tears in jeans must follow rules for shorts. Shorts: Hem must hit at least mid-thigh (see picture for reference). No running shorts. Please be conscious that shorts often ride up while walking and engaging in various physical activities. Bathing suits will follow shorts rule. I understand and agree to these expectations and that if any of these terms are violated, the Church of the Epiphany can send the participant home at the participant/guardian s expense. Youth Participant Signature Date Parent/Guardian Signature Please return to: Carly Radke, Middle School Youth Minister Deadline: April 20 th WITH $100 DOWN PAYMENT REGISTRATION WILL NOT BE ACCEPETED WITHOUT THE DOWN PAYMENT. Date

8 Church of the Epiphany PRESCRIPTION DRUG AND MEDICINE AUTHORIZATIONS (USE THIS FORM ONLY IF MEDICATION IS TO BE GIVEN TO YOUR CHILD DURING THE EVENT) Any prescriptions or over-the-counter medicine must be in the original, labeled container and stored under lock and key. *The following information must be completed before medicine is given. Student Name Name of Prescription/Medicine Prescribing Doctor Amount of Dosage Times to be given Duration of Prescription I,, herby authorize the Church of the Epiphany to dispense Parent /Guardian Name medicine to as directed above. Participants Name Signature of Parent/Guardian of Participant Date

9 Fundraising Information Dear Parents and Guardians, Attached is a request to participate in fundraising for EFC Epiphany is not responsible for covering any of the cost for Extreme Faith Camp registration and cannot promise any family a certain amount per fundraiser. Amount given per child depends on: 1. The number of shifts worked. 2. The number of teens volunteering. 3. The amount of money donated by parishioners. The fundraiser consists of helping out after Mass at hospitality, as well as participating in the Masses the weekend of April 28th and 29th as ushers, lectors, or gift-bearers. Students must participate in hospitality in addition to a role at Mass. Students must participate in one shift to raise funds, and can do all shifts. The more shifts worked, the more money you raise. Our fundraiser is only open to Epiphany parishioners or Epiphany Catholic School students. This fundraiser is primarily for families who need the financial assistance, not those who wish their child to earn their camp costs. This is a wonderful attitude to have, and we do not wish to discourage this ideal. However, the more participants we have, the less money each child actually raises, which affects families who need the financial assistance. If you would like to have your child participate in the fundraiser but give their funds to another student who is in need, please mark this on your form on the last box. A $100 deposit is still required upon registration, even if you plan to fundraise. The amount of money to be credited to your registration will be determined after the April fundraiser date. You can also pay for your full camp registration immediately, if you choose not to partake of the fundraising money. Please contact me if you have any questions. In Christ, Carly Radke Middle School Youth Minister cradke@epiphanymn.org

10 Request to Participate in Fundraising: Extreme Faith Camp 2018 **Please fill out this form in its entirety to participate in fundraising sponsored by the Church of the Epiphany for Extreme Faith Camp Participant s Name: Grade (current): Parent/Guardian s Name: Cell Phone: Home Phone: address (parent/guardian): Youth Statement: (to be completed by the participant, not parent/guardian) In 3-5 sentences, please explain why you would like to attend Extreme Faith Camp and how you think fundraising through volunteering will be meaningful to your experience at Extreme Faith Camp this summer: I allow the Church of the Epiphany to use quotes from my statement for promotional purposes, should they so desire. I also allow them to use photos of me for promotional purposes. For Parent/Guardian: Please check all that apply. I understand that by registering my child(ren) for Extreme Faith Camp, I am responsible for the registration costs, regardless of how much is fundraised through the Church of the Epiphany s fundraising opportunities. My child is ready to serve in order to receive a percentage of funds raised in the second collection for Faith Formation on the weekend of April 28-29th. He/She can come help serve at: (one shift minimum) Saturday 4:30pm Mass Sunday 7:30am Mass Sunday 9am Mass Sunday 11am Mass I would like my child to participate in the fundraiser but wish to donate our portion to the general fund. My child is willing to give a witness at the beginning of Mass to share his/her experience with EFC. Please return this form by April 20 th to Carly Radke in order to participate. Questions? Contact Carly Radke, Middle School Youth Minister at or cradke@epiphanymn.org

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