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I request the St. John Vianney Youth Ministry Program allow my son/daughter to attend High School "Sealed" Retreat on October 25th-October 27th, 2024. By requesting, I understand reasonable precautions will be taken to safeguard the health and well-being of my child and that I will be notified as soon as possible in the event of an emergency. I understand that in the case of an accidental injury I will not hold the Diocese of Phoenix, St. John Vianney Catholic Church, or SJV Youth Ministry accountable. I also understand that if my child needs emergency care. I allow Esmeralda Avila or their designate administer of care, to administer care should that be necessary. In case of sickness or accident, I authorize and consent to any x-ray exam, anesthetic, medical, dental or treatment and hospital care to be rendered to my child under the general care and advice of any physician, dentist or surgeon licensed to practice in the state of Arizona or any other state. I further understand and agree to be responsible for any such medical, dental and/or hospital expenses incurred.

Please accept my application to attend the High School Sent Retreat I understand by requesting to go, I am promising to cooperate with Esmeralda Avila and the Core Team/Staff. I understand the intention of this trip is to help form community and deepen my relationship with God and His Church. I also realize that I may not bring any drugs or alcohol. If I do not follow the above guidelines, I understand that my parents will be called, and I will be sent home at their expense.