Raker Religious School Youth Retreat December 2-4, 2022 • Camp Stein • Prescott, AZ $325.00 price per student includes: Bus, Meals, Camp Stein, Security, Staff and Programs DEPOSIT of $100.00 DUE November 2 BALANCE of $225.00 DUE November 21 Questions? Contact Tobee at twaxenberg@templesolel.org or at 480-991-7414
Retreat Agreement - Parent/Guardian Consent Form and Liability Waiver
I grant permission for my child to participate in out-of-town trip that requires transportation. This activity will take place under the guidance and direction of Temple Solel staff. A brief description of the trip follows: Event: SOLEL YOUTH RETREAT (“Retreat trip”) Date: December 2-4, 2022 Location: Camp Daisy and Harry Stein, 3400 W Camp Pearlstein Rd, Prescott, AZ 86303 Individual in charge: Tobee Waxenberg, Raker Religious School Director Contact: (602) 370-6667 Mode of transportation to and from event: Bus provided by All Aboard America. I certify that I am the parent and/or legal guardian of the above named student. I acknowledge and agree Temple Solel has my full permission to allow my child to attend the above Retreat Trip by private bus on the streets and public highways. I hereby fully, finally, absolutely, and forever release and discharges Temple Solel and its respective present, former and future directors, shareholders, members, partners, officers, employees, agents, representatives, attorneys, consultants, fiduciaries, predecessors, successors, assigns, successors, assigns, and affiliates (collectively, “Released Parties ”), of and from any and all claims, controversies, disputes, rights of set-off, liabilities, obligations, demands, damages, debts, expenses, liens, actions, and causes of action of any and every nature whatsoever, known or unknown, liquidated or unliquidated, contingent or non-contingent, existing or arising in the future, resulting from or relating in any way to the Retreat Trip and/or my child’s participation in the Retreat Trip. I acknowledge and understand further that in the event my child needs emergency or medical treatment, every attempt will be made to contact us, the parent/guardian, before such treatment is rendered, provided such contact can be accomplished without placing my child’s health at risk. In the event I/we cannot be contacted, my authorized signature below gives my/our permission to Temple Solel to secure prompt treatment.
Student Information
Raker Religious School Code of Conduct
(to be signed by student and parent/guardian)
The following Code of Conduct is in effect for the RRS Youth Retreat. These rules of behavior apply to every student for the duration of the trip. A signed Code of Conduct is a requirement for event participation.
I will attend and participate fully in each activity. I will be on time, follow all instructions, and remain with the group at all times. I will abide by the curfew given to me. At curfew time I will go directly to my assigned room and remain there until the group meets in the following morning. I will be respectful at all times to everyone I encounter. I understand that disrespect of personal and public property, disturbing peace, or other inappropriate behaviors will not be tolerated. I understand that I will pay for any damage that I cause. I understand that violations of health and safety, with as smoking materials, vaping, drugs or alcohol will not be tolerated. I agree to abide with any additional rules pertinent to a specific activity, which may be announced, and accept the consequences if I violate these rules. I understand that if I am unable to obey by these rules, parents will be called to pick me up.
I have read the above rules and indicate my acceptance with my signature.
Medical Information
We understand that if our child should need to be returned home due to illness or for other reasons, and the Temple is unable to reach us through the numbers listed on this consent form, we authorize Temple Solel to release the child to:
Student Health Restrictions Please list any allergies, dietary restrictions, health conditions, or other restrictions of which we should be aware of:
Exceptions to be listed here:
Payment
Parent/Guardian Authorization: The information on this form is correct and complete as far as I know.
As the student attending this retreat, I have read and understood the rules of the Raker Religious School Code of Conduct, and indicate my acceptance with my signature.
