• DIOCESE OF PATERSON - QUO VADIS RETREAT

  • Location: Camp Shiloh, 753 Burnt Meadow Road, Hewitt, NJ 07421, www.campshiloh.com

    Date of Event: Friday, June 24, 2022

    Arrival: 9 AM Departure: 8 PM

  • Please provide alternate emergency contact, in the event Parent/Guardian cannot be reached:

  • I understand that the Diocese of Paterson and Camp Shiloh are not responsible for transportation to/from the camp. I understand that the diocesan retreat team will supervise at all times at the camp. I understand that the rules at Camp Shiloh will be clearly stated upon arrival; and if participants do not follow their rules, parents/guardians may be asked to come pick them up. I understand that while at camp, there is participation in athletic activities, waterfront activities and adventure program.

    Iunderstand the risks involved, give permission for the above named to participate to his ability, and

    release Diocese of Paterson and Camp Shiloh of liability.

    Ihave read and agree to the above statements.

  •  
    Clear
  •  
    Clear
  • If yes, please describe reaction & management.

  • Please identify any medically necessary dietary restrictions or food allergies via Special Diet Request Form: www.campshiloh.com

    Please list medications currently used & directions. (Antibiotics, Allergy meds., Inhalers, EpiPen, Insulin, etc

  • Note: All medications should be in appropriate containers and labeled, kept with group leader and self-administered.

    In the event of an emergency, I understand that every effort will be made to notify necessary emergency contacts. However, in the event that no one can be contacted, I give permission for the Quo Vadis retreat leaders and Camp Shiloh staff to make necessary decisions regarding care, including administering first aid at camp; and if necessary, arrange for transportation to Chilton Hospital and consent for emergency medical treatment. I agree that I am financially responsible for fees associated with this medical care.

  •  
    Clear
  •  
    Clear
  •  
  • I give permission for any video or still images taken at camp to be used for promotional purposes for the Diocese of Paterson Quo Vadis Retreat and for Camp Shiloh.

  •  
    Clear
  •  
    Clear
  •  
  • Current Health Screening required by Camp Shiloh

    Any person planning to attend the retreat should plan to closely monitor their health and social habits 14 days prior to the retreat date. Anyone exhibiting any cold or flu-like symptoms should NOT attend. Anyone who has pre-existing health conditions, or has a family member with health concerns, should consider not attending the retreat for their health and safety. Please answer questions below based on current health (for the past 14 days)

     

  •  


    If answer is YES to any of the lower questions, the participant should NOT attend camp. Any onset of symptoms while at camp will result in isolation and being asked to vacate the premises to ensure the health and safety of others on site. If there are any onset of symptoms within 14 days of departure, participant should notify retreat leader and Shiloh staff immediately. I declare that all statements here are true and accurate to date and consent to all health/safety procedures of the

  •  
    Clear
  • WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT

  • I hereby request to participate in the Quo Vadis Retreat at Camp Shiloh, 753 Burnt Meadow Road, Hewitt, New Jersey 07421 to be held on June 24, 20212. I freely and knowingly provide this WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT in order to accomplish this

    In consideration of the ROMAN CATHOLIC DIOCSESE OF PATERSON'S acceptance of my registration and participation in the Quo Vadis Retreat to the fullest extent of the law, I shall indemnify, defend and hold harmless the Most Rev. Kevin J. Sweeney, D.D., Bishop of the Roman Catholic Diocese of Paterson, and his successors in office, and all employees and agents of the Diocese of Paterson and all affiliated parishes, schools, and institutions from and against any and all claims for bodily injury and/or property damage, damages, losses and expenses, including but not limited to attorney's fees, arising out of my participation in the Quo Vadis Retreat on June 24, 2022.

  • My agreement to indemnify specifically includes any and all claims, damages, losses, and/or expenses resulting from bodily injury and/or property damage, sickness, disease or death or injury to or destruction of tangible property caused in whole or in part by the negligence of a party indemnified

    My personal insurance is primary over all other insurance.

    I further agree that any and all disputes regarding my registration and participation in the Quo Vadis Retreat on June 24, 2022 as well as any and all disputes regarding this WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT, will be resolved by way of submission to binding arbitration through the auspices of the American Arbitration Association.

    In signing this release I acknowledge and represent that I have read the following WAIVER, RELEASE OF LIABILILTY AND HOLD HARMLESS AGREEMENT, understand it and sign it voluntarily as my own free act; no oral representations, statements, or inducements apart from the foregoing written agreement have been made; I am at least 18 years of age and fully competent; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same.

    Participant, please print name and sign below.

  •  
    Clear
  • Parent/Guardian of participant less than 18 years of age, please print name and sign below.

  •  
    Clear
  • Should be Empty: