Brave the Wilderness

Parent/Guardian 1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Other Phone Number Please enter a phone number.

Are You A Registered Parishioner? REQUIRED Please fill out this field.

Relationship to Children? REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian 2

First Name Please enter valid data.

Last Name Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Cell Phone Number Please enter a phone number.

Other Phone Number Please enter a phone number.

Are You A Registered Parishioner?

Relationship to Children? REQUIRED Please fill out this field. Please enter valid data.

Email Please enter an email address.

Preferred Email for Correspondence REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Child REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex As Indicated on Birth Certificate REQUIRED Please fill out this field.
- Current Grade (2022-2023 School Year) REQUIRED Please fill out this field.
- **Please note that the size given is the T-Shirt size your child will be given at Brave the Wilderness summer camp 2023!**
- T-Shirt Size REQUIRED Please fill out this field.
- Do You Have a St. Thomas More T-Shirt?
- Roommate Request? Please enter valid data.
- Youth Participation Agreement
- In checking the box below I agree to abide by any/all policies and rules established for this event. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent's expense.
  I Agree Please select this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex As Indicated on Birth Certificate REQUIRED Please fill out this field.
- Current Grade (2022-2023 School Year) REQUIRED Please fill out this field.
- **Please note that the size given is the T-Shirt size your child will be given at Brave the Wilderness summer camp 2023!**
- T-Shirt Size REQUIRED Please fill out this field.
- Do You Have a St. Thomas More T-Shirt?
- Roommate Request? Please enter valid data.
- Youth Participation Agreement
- In checking the box below I agree to abide by any/all policies and rules established for this event. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent's expense.
  I Agree Please select this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth (xx/xx/xxxx) REQUIRED Please fill out this field. Please enter a date.
- Sex As Indicated on Birth Certificate REQUIRED Please fill out this field.
- Current Grade (2022-2023 School Year) REQUIRED Please fill out this field.
- **Please note that the size given is the T-Shirt size your child will be given at Brave the Wilderness summer camp 2023!**
- T-Shirt Size REQUIRED Please fill out this field.
- Do You Have a St. Thomas More T-Shirt?
- Roommate Request? Please enter valid data.
- Youth Participation Agreement
- In checking the box below I agree to abide by any/all policies and rules established for this event. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent's expense.
  I Agree Please select this field.

Who is allowed to drop off/pick up the child(ren) before and after camp? REQUIRED Please fill out this field.

NOTE: If someone tries to pick up the child and is not on this list we will not release child to said person. We will notify you and ask for your permission before releasing the child to anyone not included on this list.

I understand that if my child will be driving home without adult supervision St. Thomas More is not responsible for my child once the camp has ended and my child has left the property.

I Agree Please select this field.

Medical Information

Doctor's Name REQUIRED Please fill out this field. Please enter valid data.

Doctor's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Insurance Name REQUIRED Please fill out this field. Please enter valid data.

Insurance Group Number REQUIRED Please fill out this field. Please enter valid data.

Insurance Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Guardian Electronic Signature REQUIRED Please fill out this field. Please enter valid data.

Medical Consent

In the event of an emergency, I hereby give permission to the staff of St. Thomas More Catholic Church to seek emergency medical transport and/or treatment for my child(ren) named above. I will be responsible for all costs incurred. I wish to be advised before further care is given by the hospital or doctor.

I Agree Please select this field.

Please List All Medications/Allergies/Special Health Information Including Anxiety, Depression, or Other Needs REQUIRED Please fill out this field.

Please List Any Medications You Would Like Us to Be Aware Of REQUIRED Please fill out this field.

Medications

My child will bring all such medications, well labeled, that are necessary. Names of medications and concise diretions for seeing that the child takes such medications, including dosage and frequency are as follows:

Medications, Dosage, and Instructions: REQUIRED Please fill out this field.

Please Select One of the Following:

I hereby grant permission for nonprescription medication (such as Tylenol, throat lozenges, cough syrup) to be administered to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter. I grant permission.

I hereby do not grant permission for medication of any type, whether prescription or nonprescription may be administered to my child unless the situation is life-threatening and emergency treatment is required I do not grant permission.

Video/Photography Consent

As parent/guardian, I understand that promotional pictures and videos ( individual and group) may be taken during the camp. I give permission for my child(ren)'s pictures (named above) to be used for church promotional materials such as newsletters, web pages, social media such as Facebook and Instagram, calendars, Power Point presentations, or videos to promote or highlight activities of the teens and camp experience.

I Agree Please select this field.

Consent and Liabiltiy Waiver

I grant permission for my child(ren) to participate in Brave the Wilderness on June 26, 2023 thru June 30, 2023 at Forest Glen Camp in Huntsville, Texas.

I Agree Please select this field.

In the event of any accident or injury, I agree on behalf of myself, my child(ren)'s other parent if known or living, the child(ren) named above or our heirs, successors, and assigns, to hold harmless and defend the Archdiocese of Galveston-Houston, its pastor or any representative of Faith Formation, unless the parties involved were careless and negligent. Effective for all Faith Formation activities associated with St. Thomas More and its employees.

I Agree Please select this field.

Preferred Parent/Guardian Name for Correspondence REQUIRED Please fill out this field. Please enter valid data.

I grant permission for my information to be submitted to Flocknote so that the CCE department can communicate with me. I recognize that this is the primary mode through which information regarding Brave the Wilderness camp will be transmitted.

I Agree Please select this field.

Your registration will not be complete untill you have paid in full. If you need financial assistance, you can reach the CCE office at 713-729-3435.

Payment Explanation:

Due to a limited number of spots we are asking for a non-refundable deposit of $100 per teen. We will not consider you registered until you have paid this deposit. After this, we will ask in the coming months for the second deposit of $150. The final price of the retreat is yet to be determined but will not exceed $425 total per teen. As we get closer to the retreat and plan with our final numbers we will then be able to determine a final price. Again, the final price will NOT exceed $425 per teen. If any of this is confusing please do not hesitate to reach out to the CCE office at 713-729-3435.

Payment REQUIRED Please fill out this field.

Brave the Wilderness

Brave the Wilderness Summer Camp!

Brave is for all high school teens (9th-12th grade) through the 2022-2023 school year.

Brave Registration