ECHO Louisiana Teen Registration

NOTE: We are glad you are here! Due to the retreat center, space for ECHO Louisiana is limited this summer. Your acceptance to ECHO depends on a number of factors, including available space, housing, and male and female ratio. We cannot guarantee everyone who desires to come will be able to be accepted. We will notify you of your status via email after submitting your registration. Thank you!

You must be a rising junior, rising senior, or recently graduated senior in high school as of Summer 2020 to qualify for this camp.

participant information

* Indicates required field

Participant's Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Age (At The Time of Retreat) *

Sex *

Male Female

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

T-Shirt Size *

parent information

1. Parent/Guardian Name (First, Last) *

First

Last

2. PARENT/GUARDIAN NAME (FIRST, LAST) *

First

Last

Mailing Address (If Different from Participant Mailing Address) *

Line 1

Line 2

City

State

Zip Code

Country

Primary Email *

Secondary Email *

Primary Phone Number *

Secondary Phone Number *

participant's medical information

Health Insurance Provider *

Policy Number *

Name of Primary Care Physician *

Phone Number of Primary Care Physician *

Emergency Contact Person *

Phone Number of Emergency Contact *

Relation to Participant *

NOTE REGARDING PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS:
We have a licensed nurse as part of the ECHO staff. Upon arrival, please give any prescription medication to the camp nurse located at the registration area with specific dosage instructions for your child. We ask that medications be delivered in this manner to keep your child and other children safe. These medications will be returned to your child at the end of camp.

We keep basic over-the-counter medications in stock at ECHO, including Advil, Tylenol, Benedryl, Zyrtec, Allegra, Claritan, Pepto-Bismol, cold and flu medications, and all first-aid supplies. Participants will be instructed to see the camp nurse if any of these are needed during camp.

A detailed log of all medication given will be kept by the camp nurse for the safety of all participants.

PLEASE LIST ANY PRESCRIPTION OR OVER-THE-COUNTER MEDICATIONS YOUR CHILD WILL TAKE TO ECHO. IF NONE, PLEASE TYPE "NONE": *

Please list any environmental or medical allergies. If none, please type "none": *

medical liability waiver

I hereby authorize Dumb Ox Ministries to carry out the wishes I have named (herein) in areas of emergency medical treatment and other cases of illness for myself/my child. This authorization inclusively extends from July 27 - 30, 2020. I hereby warrant, to the best of my knowledge, I/my child is in good health, and I assume all responsibility for myself/my child.

In the event of an emergency, I hereby give permission to transport me/my child to a hospital for emergency medical or surgical treatment. I ask you to advise the person(s) listed as the emergency contact to any further treatment by the hospital or doctor. I assume full financial responsibility for any medical treatment expenses I may incur. I agree to either pay for services upfront, or if Dumb Ox Ministries pays, I agree to be billed and reimburse their expense.

By selecting the box below and providing my signature, I also give permission to the designated Dumb Ox Ministries/ECHO staff to disperse my child's prescription medication according to the instructions that I will provide. I also give permission to the designated Dumb Ox Ministries/ECHO staff to disperse any needed over-the-counter medications after review by the designated nurse or medical professional on site, and with the consultation of the medical information I listed above.

Please click below. *

I Understand and Agree

Please Type Your Full Name Below. This serves as your signature agreeing to the terms above. *

dietary restrictions

NOTE REGARDING DIETARY RESTRICTIONS:
We do our best to work with the retreat center to provide great food options for those with dietary restrictions. However, in some instances, our cooks are unable to provide for all needs. If this situation arises, we will contact you regarding other dining options.

Please list any food allergies or dietary restrictions we should be aware of: *

why echo?

Please have the participant answer the following questions:

Will this be your first ECHO? *

Yes No

If you answered no, please list any past ECHO experiences you have attended. *

ECHO is an immersive experience into the depths of our identity as men and women through the lens of St. John Paul II's Theology of the Body. We explore themes of sexuality, vocation, prayer, and relationships. We want to make sure you want to dive in!

Please briefly explain why you want to attend ECHO *

travel plans

We are able to offer shuttles from and to Alexandria International Airport (AEX). If you will be flying, we will contact you regarding travel and shuttle arrangements.

What are your travel plans for ECHO? *

I will be driving I will be flying I am not sure yet

housing:

Maryhill Renewal Center offers single sex, double occupancy rooms with private bathroom for teens. If you have a roommate preference, please list his/her name below: *

safe environment regulations & background checks

Please note: All teen participants who will be 18 years or older at the time of the retreat MUST provide proof of up-to-date safe environment/VIRTUS training and must provide proof of a background check, per diocesan regulations. If you will be 18 or older at the time of ECHO and do not provide this information, we will not allow you to attend the retreat. Please contact your diocesan safe environment coordinator to access this information, and please email this information to echocamp@dumboxministries.com. We are able to run a background check on your behalf for a fee. If you have questions about this, simply contact us at echocamp@dumboxministries.com or (985) 951-2215 and we will get you settled.

Please select the option that applies to you: *

I will be 18 years or older at the time of the retreat and I understand the above regulations I will not be 18 years or older at the time of the retreat

general liability waiver

As parent and/or legal guardian, or myself if 18 years or older, I remain legally responsible for any personal actions taken by myself or the above-named minor ("participant"). I agree on behalf of myself/my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Dumb Ox Ministries, the Diocese of Alexandria, Maryhill Renewal Center, their officers, directors, agents and staff, chaperons, or representatives associated with the event, arising from or in connection with myself/my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Dumb Ox Ministries, the Diocese of Alexandria, Maryhill Renewal Center, their officers, directors, staff, agents, chaperones, or representatives associated with the activity for reasonable attorney' fees and expenses arising in connection therewith.

Please click below *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the above terms. *

photo release & video consent

In consideration of the taking and use of the photographs or video footage of the named below, for good and valuable consideration herein acknowledged as received, I hereby grant to Dumb Ox Ministries the irrevocable and unrestricted right and permission to take, use, re-use, publish photographic pictures of me/my child or in which he /she may be included, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction therewith.

I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or another matter that may be used in connection therewith or the use to which it may be applied.

In exchange for the benefits derived by my/my child's participation, I hereby agree that I, my heirs, distributes, guardians, legal representatives, and assigns to do release and will indemnify, hold harmless the photographer or videographer, Dumb Ox Ministries for claims for libel or violation of any right of publicity or privacy or privacy arising out of or in connection with my participation in the photography or videography project, from whatever cause, including the active or passive negligence of the photographer, videographer, or Dumb Ox Ministries.

I have carefully read this agreement and fully understand its contents and give my consent on behalf of myself/my child. I am aware that this is a release of liability and sign it of my own free will. *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the above terms. *

ECHO code of conduct

VIOLATIONS OF ANY OF THE REGULATIONS LISTED BELOW MAY RESULT IN YOUR IMMEDIATE RETURN HOME AT YOUR EXPENSE:
1. All camp directors, chaperones or counselors are to be respected at all times; instructions are to be followed.
2. Alcoholic beverages, tobacco, illegal drugs, and weapons or dangerous items of any sort are positively forbidden.
3. Room assignments may not be changed once assigned.
4. Members of the opposite sex may not visit each other’s rooms at any time.
5. Inappropriate public or private displays of affection are not allowed at any time during the camp.
6. No pursuit of romantic relationships are allowed during camp.
7. No minor is permitted to leave the retreat center without the permission and escort of a chaperone.
8. Anyone damaging property will be held responsible for the cost of damages. Dumb Ox Ministries, the Diocese of Alexandria, and Maryhill Renewal Center are not responsible for damage expenses that an individual incurs. Theft of property is forbidden.
9. If a participant uses special prescription medication (i.e. insulin, Ritalin, pain medication, etc.), the Camp Director reserves the right to have a staff member administer such medication.
10. You must be on-time for all scheduled activities. Failure to follow this rule may result in loss of privileges at this camp.
11. Once curfew has been established, NO ONE will be allowed out of their rooms.
12. Obscene or abusive language, and inappropriate comments will not be tolerated.
13. Modesty in dress and behavior is required.
14. Participants must act as positive role models at all times during the camp and respect the property and residents of Maryhill Renewal Center.
15. Participants must participate in all scheduled activities.
16. CAMPERS ARE RESPONSIBLE FOR VALUABLES: Please do not bring valuables such as jewelry, expensive electronics, etc. Dumb Ox Ministries, the Diocese of Alexandria, and Maryhill Renewal Center are not responsible for loss, damage, or theft that may result to such items.

I have read and discussed the regulations for ECHO: A Theology of the Body Camp, or with my son/daughter and he/she or I am aware of them. I understand that if I/my child violates any of the above-mentioned rules or any others deemed necessary by the Camp Director and adult chaperones, I agree that I/my child can be sent home immediately at my expense. *

I Understand and Agree

Please type your full name below. This serves as your signature agreeing to the above terms. *

cancellation policy

1. There is a non-refundable deposit of $100 required to secure your spot at ECHO. In the event of cancellation for any reason, this amount cannot be refunded.
2. If cancellation occurs before Friday, July 10, 2020, you will be refunded any monies paid over $100.
3. If cancellation occurs after Friday, July 10, 2020, we are unable to reimburse any ECHO registration fees and you are still responsible for the full registration balance.

I understand and agree to abide by the above ECHO cancellation policy. *

I Understand and Agree

If you are 18 or older, please type your full name in the box below. If you are a minor, please have your parent or guardian type their name below. This serves as your electronic signature. *

payment

REGISTRATION COST:
$399

PLEASE SELECT YOUR PREFERRED PAYMENT OPTION: *

Pay In Full Pay Deposit ($100), Remaining Balance Due July 10, 2020

FINAL NOTE: When you click SUBMIT below, you will be redirected to the payment information page. We are able to accept online payments as well as payments via check. Please keep in mind that until at least the $100 deposit is received, we are unable to accept your registration.

Submit