Kairos Retreat Policies & Permission Forms Bring home to Parents TODAY!

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1 Kairos Retreat Policies & Permission Forms Bring home to Parents TODAY! ***Please Read All Information Carefully**** Complete & return all forms (retain first and back page) to the Reception Desk Main Entrance (no check needed, IT IS INCLUDED IN TUITION) on or before Dear Retreatant, Friday May 26 th 2017 May 16 th 2017 I hope that you re excited & looking forward to the Kairos experience as much as the Student / Faculty leaders & that it will be a positive experience for you. This is a Senior Retreat graduation requirement. You are scheduled for Kairos on Tuesday June 6 th to June 8 th If you have any questions, conflicts or problems, please me immediately at Sincerely yours, Ms Maria Nowicki Kairos Director

2 STUDENT CONTACT INFORMATION AND POLICY AGREEMENT FORM Student s Name: Student s Address: Home Phone: Cell Phone: Address: ( ) ( ) I,, as a student of Fenwick High School, and in consideration of being permitted to participate in the Kairos Retreat Program, agree to abide by and adhere to the Fenwick Student Conduct Policy for Overnight/Extended Trips, the Student Behavior and Discipline policies in the Fenwick Parent-Student Handbook, and the rules and procedures of the Jesuit Retreat Center and those established by the Director(s), supervisors and chaperones participating in the retreat. I have also been made aware regarding the academic requirements and policies. And that I understand that I am responsible for all homework and make up work in all classes. I also understand and accept that failure to abide by any rules of the retreat or retreat center may result in my being asked to leave the retreat center and that my parents/guardians will assume responsibility for my transportation from the retreat center at any time. Student s Signature: Parent/Guardian s Signature: Parent/Guardian s Signature: I have special needs regarding my diet [describe]:.

3 PARENT/GUARDIAN CONTACT INFORMATION Student s Name: Parent/Guardian s Name: Home Address: P/G Home Phone: ( ) P/G Work Phone: ( ) P/G Cell Phone: ( ) Emergency Phone: ( ) P/G Address: Parent/Guardian s Name: Home Address: P/G Home Phone: ( ) P/G Work Phone: ( ) P/G Cell Phone: ( ) Emergency Phone: ( ) P/G Address: HEALTH INSURANCE INFORMATION Subscriber/Employee Name: Insurance Company: Policy/Group Number: Group Name/Employer: OTHER HEALTH CONCERNS AND MEDICATIONS Please list any and all medical concerns and/or mediations taken by the student. If the student is self medicating, please provide us with information of what medication(s) is/are being taken by the student in case of emergency. If the student needs to be given medication of any type, please include the name of the medication and when the medication is to be administered.

4 PARENT/GUARDIAN PERMISSION FORMS I,, or We, and, as parent(s)/guardian(s) of hereby represent and warrant that I/we have read or have been advised of and agree to the Fenwick Student Conduct Policy for Overnight/Extended Trips, the Student Behavior and Discipline policies in the Fenwick Parent- Student Handbook, and the rules and procedures of the Jesuit Retreat Center and those established by the Director(s), supervisors and chaperones participating in the retreat. I/We further acknowledge and agree that by participating in the retreat my/our student may be exposed to certain risks and activities that might have the potential for causing personal injury or damage, including without limitation, bus travel, educational and spiritual activities, overnight lodging, meals and recreation time. In consideration of Fenwick High School allowing my/our student to participate in the retreat and for good and valuable other considerations, I/we, on my/our own behalf and behalf of my/our heirs, executors, administrators and assigns, and on behalf of my student and any person or entity that might have a claim for injury or damage to the student, do hereby release and forever discharge Fenwick High School, its faculty members, administrators, officers, directors, trustees, employees, agents and representatives and any retreat director, supervisor or chaperone of and from any and all claims, demands, loses and injuries, of any nature and however arising, including without limitation, claims or causes of action for any and all lose of personal property, illness, injury or death, incurred or sustained by me or my/our student as a result of attending, participating in, and traveling to and from the retreat. PERMISSION FOR EMERGENCY MEDICAL TREATMENT In the event of an emergency which requires medical attention, evaluation or treatment, I/we hereby give our permission to transport my child to a hospital, acute care center or physician for evaluation and treatment. I understand that all reasonable efforts will be made to contact me prior to any medical treatment is rendered. In the event that a physician who has evaluated my child advises that emergency treatment must be rendered before I can be contacted, I hereby grant my permission for such physician(s) or hospital personnel to render such treatment as may be necessary to treat my child.

5 FENWICK HIGH SCHOOL STUDENT CONDUCT POLICY FOR OVERNIGHT/EXTENDED TRIPS The following policies have been established to insure that every student who participates in an organized trip supervised by Fenwick personnel will benefit from the experience and will be safe throughout the trip. This trip is a co-curricular activity like many under the auspices of Fenwick High School. Each student is expected to behave in the same manner he/she would at any school activity. The underlying reason for any activity in which our students are engaged is to enhance their educational and spiritual experience. No student shall be permitted to partake in any off-campus overnight/extended trip unless he/she and his/her parent or guardian have read together the following policies and have signed that the student will comply with these provisions. 1. The students will understand that they represent Fenwick High School at all times and will not conduct themselves in a manner that reflects negatively on the reputation or identity of the school. Applicable rules and regulations in the Student/Parent Handbook are in effect and must be observed. It is understood that if a student willfully disregards these rules, the supervisor/chaperone will notify the parents/guardian. Serious consequences, including suspension/expulsion, may be recommended by the Dean of Students or the Disciplinary Board. If parents need to be notified, an administrator of the school will also be contacted. Law enforcement agencies will be notified of, and involved in, situations deemed appropriate/necessary by the retreat supervisor or as required by law. 2. The students are subject to the authority of the supervisor and chaperones at all times. If a student has any concern about the behavior of fellow students, they are duty bound to bring these concerns to the supervisor and/or chaperone. 3. Major infractions may result in the student being sent home. In such case parents/guardians will be notified and are responsible to pick students up or make arrangements for the student s transportation from the retreat center at the parent s expense with no refund for any remaining portion of the retreat. Any additional expenses will be charged to the student/parents. Disciplinary action will be determined upon the student s return to school. 4. In the event of illness or accident, the supervisor will determine the course of action to follow and shall be authorized to act in loco parenti, that is, to proceed in the place of the parent. Teachers shall not assume liability, either expressed or implied, for an action taken in the best interest of the student. Parents agree to assume any medical expenses not covered by their own family medical insurance policies. 5. Any medication that must be administered during the overnight/extended trip, either over the counter or prescribed medicine, requires a physician s written order and parental authorization be given to the trip supervisor. Required medication must be in a properly labeled container. The student may carry and self-administer the medication during the trip. 6. The nightly curfew will be when students are dismissed to bed following the evening s final activity. Students are expected to be in their own room with the lights out at this time. Bed checks will be made. Students may not leave the retreat center at anytime. The retreat center staff has been advised to notify the supervisor if there is any infraction of this rule.

6 7. Smoking is prohibited. 8. The school s alcohol and substance abuse policies will be adhered to. 9. All bedrooms are for the assigned student s use only. No student may have any other student(s) in their room at any time. 10. Students must be on time for all scheduled activities and for each meal. Each student will fully participate in each day s program. Students will not deviate from the schedule, program, or directions of the chaperones without their consent. 11. Students must respect retreat center property. The student is responsible for any damage or misappropriation of retreat center property. The student is responsible for restitution should any damage / loss of property occur. 12. Students must be considerate and respectful of the rights of the retreat center residents and/or their guests. Unnecessary and loud noises, such as slamming doors, running in hallways, and loud music, are strictly forbidden. 13. Students are not permitted to change assigned rooms. 14. Students are responsible for respecting the property of the transportation service of the school. The student is responsible for any damage or misappropriation of the property of the transportation service. The student is responsible for restitution should any damage or loss of property occur. 15. Students will not enter into any vehicle except the ones that are provided by the school. Students will not engage in any activity with persons unfamiliar to the supervisor and chaperones without their consent. 16. Student s luggage must have identification clearly visible. Students are responsible for contents of their luggage and are asked not to bring any personal property of value. The signature of either parent to this policy statement shall constitute full permission for the student named below to participate in the trip. It is likewise understood that Fenwick High School disclaims all legal responsibility on any matter whatsoever. We have read this document together and agree to the conditions as outlined above: Parent s Name (print) Student s Name (print) Parent s Signature Student Signature Date Date

7 KAIROS INFORMATION SHEET Dates of the Retreat: Tuesday June 6 th until Thursday June 8 th Location of the Retreat: Bellarmine Retreat House 420 W. County Line Road Barrington, IL Telephone: FAX Please make sure that your parents have these numbers. Transportation: We will travel as a group to the retreat, leaving the school s parking lot at 5.45 PM on Tuesday June 6 th Please be in the Link by 5:30p.m., when attendance will be taken. Meals: Tuesday- No meal will be served. Eat at home before you leave. Wednesday: Breakfast, Lunch, & Dinner will be served at the retreat house. Thursday:-Breakfast & Lunch will be served at the retreat house BRING: Bring ONLY the items listed below. Do not bring a robe unless you wish to wear it in your room. Do not bring strange items which you maybe told are needed. Such requests were initiated by some of the previous retreatants as a joke. It has gone too far! No shot glasses, golf balls, light bulbs etc. Bring casual clothes for two days. Towels and sheets are provided by the retreat house. General items you need to bring: soap, shampoo, toothbrush, tooth paste, toilet articles. Weather permitting, we will have an outdoor recreation period. Shoes get muddy. Bring an extra pair of shoes or slippers and a plastic bag for soiled shoes and clothing. DO NOT BRING: School books, newspapers, magazines, radios, televisions, MP3 players, snacks, or playing cards. We also ask that all cell phones be turned off for the duration of the retreat. The Kairos retreat is a school-sponsored function. The school rules regarding the possession or use of alcohol and/or controlled substance are in force. Anyone who is suspected of being intoxicated or of using controlled substances before or during the retreat will be sent home immediately.

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