YE: Magnify 26 | HS Women's Retreat

Retreat Team

Sarah Daszczuk Retreat Host

Meg Aspinwall Retreat Musician

Location Information

Location Name
Camp Whitcomb/Mason - James Lodge
Address
Near W287N8677 Center Oak Rd, Hartland, WI, 53029 US
Directions
Google, Bing, MapQuest

Participant Info

Name of Student

Current Grade

Date of Birth

Address

Parish Group

Parish Leader

Parent/Guardian Info

Parent/Guardian 1 Name

Parent/Guardian 1 Email

Parent/Guardian 1 Phone

Yes, it's okay to send me text messages including order confirmations, updates, event reminders, and event information. Message frequency varies. Message and data rates may apply. Reply HELP for help, STOP to cancel. View our terms of service & privacy policy.

Alternate Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Consent To Participate and Indemnity Agreement

PARENT CONSENT TO PARTICIPATE AND INDEMNITY AGREEMENT:

In consideration for my child/ward’s participation, I agree to reimburse and indemnify the parish or Archdiocese of Milwaukee for all reasonable legal and court fees incurred by the parish or Archdiocese in defending a lawsuit that I or my child/ward may bring against the parish or Archdiocese of Milwaukee which relates to Magnify: High School Women's Retreat if the parish or Archdiocese is found not legally liable by the courts and prevails in the lawsuit. If the parish or Archdiocese is found legally liable for injuries sustained by child/ward, this paragraph will not apply.

I certify that I have an understanding of this agreement and any risks and hazards associated with participation in Magnify: High School Women's Retreat. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish or Archdiocese to clarify any concerns or questions about the activity or this agreement that I may have had.

I have read the information above and give consent for my child to participate in all aspects of this field trip.

I, the undersigned, agree to the terms above.

Name

Date

Photo/Video Release

I hereby consent that any still or electronic image and/or video recording, in which my child may appear, may be used by the Archdiocese of Milwaukee. I understand that these materials are being used for promotion of Magnify: High School Women's Retreat and/or the Archdiocese of Milwaukee. The images and/or recordings may be used to support participation, fundraising, evangelization and other communication efforts.

I release the staff and volunteers and I understand and agree that the use of my picture is not an invasion of privacy. Neither I, nor anyone claiming to be speaking on my behalf, will later object to the Archdiocese's use of these images and/or recordings.

Check the box if you opt out of any image, photograph, or video of your child to be posted or published to social media by any chaperone, parish, or archdiocesan personnel for this retreat.

Medical Information & Release

Emergency Medical Treatment & Contact
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.

If you are unable to reach a parent/guardian at the above numbers, contact:

Name (not a parent)

Relation to Participant

Phone Number

Alternate Phone

Physician & Insurance Information

Physician's Name

Physician's Phone Number

Name of Medical Insurance

Policy Number

Pertinent Medical Conditions, Including Allergies and Special Dietary Needs:

Medications
List all medications, prescription and over-the-counter, that the student currently takes at home and during the school day. Include all as-needed and emergency medications. Medications not authorized for self-carry must be in original container and given to the designated supervisor.

Note: for all prescription medications, a Medical Provider Consent form must be filled out by your medical provider and on file with the Magnify: High School Women's Retreat staff prior to your week. Find the electronic form here.

Medications

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 parish or Magnify Retreat staff to give your child non-prescription medication, such as acetaminophen, throat lozenges, cough syrup, or antacid?

I give permission

Yes
No, I wish to be contacted first

Inhaler/Epi-Pen Only:

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 parish/archdiocese permission for emergency and other medical treatment, including the administration of the above prescription and nonprescription medication(s).

I, the undersigned, agree to the terms above.

Name

Date Field

Billing Information

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Saturday, February 7 - Sunday, February 8, 2026

Camp Whitcomb/Mason in Waukesha, WI

Saturday 10am - Sunday 2pm

Retreat Team

Sarah Daszczuk Retreat Host

Meg Aspinwall Retreat Musician

Location Information

Participant Info

Parent/Guardian Info

Consent To Participate and Indemnity Agreement

Medical Information & Release

Billing Information