2021 Matthew 25 Registration
Work Camp Information:
June 21-25, 2021
Cost: $75 before May 1st
$100 between May 1st and May 20th

With the current health conditions, our Matthew 25 camp may take a different spin. We will email out details about fundraising opportunities and what camp will look like as we learn more about what COVID-19 will look like this Spring and Summer. We are hoping for a more traditional camp this year.

Please call or email Corinna or Bryan if you have any questions.
Corinna Ramsey 262-345-3897; ramseyc@archmil.org
Bryan Ramsey 262-253-2915; ramseyb@archmil.org
If your parish is participating, you can feel free to reach out to your youth minister also. All are welcome!

Thank you for your Love of Christ through serving others!
Bryan and Corinna
Directors of Youth and Young Adult Ministries
Good Shepherd and St. James Parishes
Email address *
Participant Information
FIRST NAME OF SON/DAUGHTER *
LAST NAME OF SON/DAUGHTER *
YOUTH EMAIL
GRADE (APRIL 2021) *
GENDER *
PARISH / FRIEND OF *
SHIRT SIZE FOR PARTICIPANT (ADULT SIZES ONLY) *
How many M25 caps/hats would you like to purchase? They are $15 each. (This is an optional purchase.) *
At this time, we are not sure what fundraising will look like for this year. We think that we will have a flower sale in the spring. If we have fundraising available, would you like to participate? Please note that the cost of camp is $75 before May 1st and $100 between May 1st and May 20th. *
Parent/Guardian Information
PARENT/GUARDIAN FULL NAME *
HOME ADDRESS *
HOME PHONE
WORK PHONE
CELL PHONE *
SECONDARY PARENT EMAIL
EMERGENCY CONTACT - If you are unable to reach me at the above numbers please contact this person: *
EMERGENCY CONTACT BEST PHONE DURING EVENT *
Medical Information
NAME OF MEDICAL INSURANCE *
MEDICAL INSURANCE POLICY NUMBER *
PHYSICIAN'S FULL NAME *
PHYSICIAN'S PHONE *
Please list any health information that might be needed by our staff or health emergency personnel: allergies, chronic conditions, recent or current injuries, etc.
Other medical treatment: In the event that the child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, do you grant permission for supervisors to give your child non-prescription medication, such as acetaminophen, throat lozenges, cough syrup, or antacid? *
Medications: List all medication names, prescription and over the counter, that the student currently takes at home and during the school day so we know what they may have in their system on a normal camp day.
Please list all prescription medications that we will have to administer DURING THE CAMP DAY. (Name, dose, route given, and frequency.) If prescriptions are to be given, we will need separate medical provider consent.
INHALER/EPI-PEN
Clear selection
ANY FOOD ALLERGIES TO BE AWARE OF?
Chaperone Information
** Enter your name if you would like to help chaperone for one or more days.
CHAPERONE PHONE NUMBER
CHAPERONE EMAIL ADDRESS
AVAILABILITY OF CHAPERONE
SHIRT SIZE FOR CHAPERONE
Clear selection
WOULD YOU LIKE TO BE PLACED WITH YOUR CHILD'S TEAM?
Clear selection
COVID-19 Consent Form
Section 1: The COVID-19 Pandemic
The novel coronavirus, COVID-19 (hereinafter “COVID-19”), has been declared a worldwide pandemic and is extremely contagious. As a result, in order to resume in-person activities at the above-referenced parish, collaborating parishes, or multi-parish community (hereinafter “Parish”), social distancing and other safety measures have been enacted at Parish. The Parish has put in place safety measures and standards of behavior to reduce the spread of COVID-19 while attending work camp. Even with implementation of safety protocols, Parish cannot guarantee that you, members of your household, or your child(ren) will not become infected with COVID-19 and cannot guarantee that attendance at work camp will not increase your risk and/or your child(ren)'s risk of contracting COVID-19.

Section 2: Direction to Parents and Legal Guardians
In addition to the safety measures being implemented by Parish, the above-named parents and/or legal guardians (hereinafter “Parents and Legal Guardians”) hereby agree to adopt the following safety measures of their own to help ensure the safety of all work camp youth, families, chaperones, and staff. Prior to attendance of child(ren) at work camp, Parents and Legal Guardians shall take the necessary steps to determine whether their child(ren) are exhibiting symptoms of COVID-19, including, but not limited to, temperature checks for fever (as defined by the CDC as at or above 100.4), review for the presence of any symptoms commonly associated with COVID-19, such as cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea. Should your child(ren) exhibit any symptoms of COVID-19, we require that you keep your child(ren) home.

Section 3. Students Exhibiting COVID-19 Symptoms at Work Camp
Should a child demonstrate any symptoms of COVID-19 while attending work camp, Parish will contact that child’s Parents and Legal Guardians to require that child be picked up from Parish and taken home in a timely manner.

Section 4. Known Exposure to COVID-19.
In the event that a child or a household member living with a child has been knowingly exposed to COVID-19, the Parents and Legal Guardians of that child hereby agree to immediately take the following steps:
1.Contact child’s primary care physician
2.Notify the local health department.
3.Follow the local health department’s protocols for quarantine, isolation, and return to work or school.
4.Notify Parish of the exposure.
5.Prior to child returning to work camp, Parents and Legal Guardians agree to contact Parish to inform Parish of the steps taken to ensure that child is no longer contagious based on the protocols and guidelines of the local health department.

Section 5. Positive COVID-19 Test.
In the event that a child or a household member living with a child has tested positive for COVID-19, the Parents and Legal Guardians of that child hereby agree to immediately take the following steps:
1.Contact child’s primary care physician
2.Notify the local health department.
3.Follow the local health department’s protocols for quarantine, isolation, and return to work or school.
4.Notify Parish of the exposure.
5.Prior to child returning to work camp, Parents and Legal Guardians agree to contact Parish to inform Parish of the steps taken to ensure that child is no longer contagious based on the protocols and guidelines of the local health department.
6.Provide Parish with evidence of child’s negative COVID-19 test result and/or a release from child’s primary care physician.

Section 6. Acknowledgement of Risk
By signing this COVID-19 Pandemic -Student/Family Statement of Operations, Understanding, and Consent for Work Camp, I/we acknowledge the contagious nature of COVID-19, that my/our child(ren) and I/we may be exposed to or infected by COVID-19 by attending and/or working and/or volunteering at work camp, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/we understand that the risk of becoming exposed to or infected by COVID-19 at the above-named Parish may result from the actions, omissions, or negligence of myself/ourselves and others, including, but not limited to Parish employees, volunteers, students and their families.

I/we further agree on behalf of myself/ourselves, my/our child (student) named herein, and my/our heirs, successors, and assigns, to absolutely release, defend, indemnify, and hold harmless the named Parish, teachers, volunteers, and the Archdiocese of Milwaukee, its directors, officers, employees, attorneys, agents, representatives, and insurers/third-party administrators (hereinafter collectively referred to as the "Indemnified Parties") from any and all claims or causes of actions in any way related to COVID-19, brought by any person or entity, including but not limited to, all claims and causes of action based on the alleged negligence of the Indemnified Parties, other third parties, or my own negligence.
I/We acknowledge that I/we have read the foregoing COVID-19 Consent Form and that I/we understand and agree to its contents. By entering my full name, I attest that this constitutes my legal electronic signature on this form.
Indemnity Agreement, Medical Authorizations, and Photo/Video Release
Indemnity Agreement:**In consideration for my child/ward participation, I agree to reimburse and indemnify parishes for all reasonable legal and court fees incurred by parishes in defending a lawsuit that I or my child/ward may bring against parishes, which relates to the above named activity if is found not legally liable by the courts and prevails in the lawsuit. If the parishes are found legally liable for injuries sustained by son/daughter/ward, this paragraph will not apply. I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I have the opportunity to fully discuss this agreement with a representative of the parishes to clarify any concerns or questions about the activity or this agreement that I may have. As parent or guardian of the above named student, I give permission for my child to participate in the field trip described above.

**In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

Medical Authorization: I/we agree that in case of injury or medical emergency, I understand that a reasonable effort will be made to contact me. In the event that I cannot be reached, I hereby give permission for the physician selected by the parishes employee or representative to hospitalize, to secure proper treatment for, and to order injection, anesthesia, medication, or surgery for my child.

Parent Consent for Medical Treatment and administration of medication: 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. I give the parishes permission for emergency and other medical treatment, including the administration of the above prescription and non-prescription medication(s).

Photo and Video Release: I hereby give my permission to the parishes for photographs and/or videos that may include my child's image to be used in promotional materials. This includes any prints, slides, copies, reductions, or any other processes or treatments necessary to make a photograph/video for reproduction purposes. I release all rights and privileges for financial obligations for this permission.
By entering my full name, I attest that this constitutes my legal electronic signature on this form. *
A copy of your responses will be emailed to the address you provided.
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