Editing previous response:

Please fix the highlighted areas below before submitting.

Junior Retreat

Location: Camp Auxilium, Newton NJ

Date: December 19, 2024

Cost: Covered by MHCA

By completeing this form, I permit my daughter to attend the MHC Academy Junior Class Retreat. She will travel to Camp Auxilium in Newton, NJ on Thursday 19, 2024 via MHC Academy school vehicle with Sr. Pamela Rose and Sr. April Hoffman who are serving as chaperones, OR will be responsible for her own transportation. See below. Students are to dress in casual, appropriate attire. Lunch and snacks will be included.

Student Last Name*

Answer Required

Student First Name*

Answer Required

Parent/Guardian First Name*

Answer Required

Parent/Guardian Last Name*

Answer Required

Parent/Guardian Email Address*

Answer Required

Parent/Guardian Phone Number*

Number Required

Emergency Contact Name*

Answer Required

Emergency Contact Email*

Answer Required

Emergency Contact Phone Number*

Number Required

How will your daughter transport to Camp Auxilium, Newton NJ?*

Answer Required

My daughter will be responsible for her own transportation to and from Camp Auxilium. She should arrive by 8:25 AM and picked up by 2:00 PM

My daughter will be riding the MHCA school vehicle to Camp Auxilium. She will arrive at MHCA by 7:20 AM

Important medical information that we should know

Answer Required

I hereby authorize MHC Academy, its directors, and representatives to obtain medical treatment for my daughter for any injury or illness during this outing. I hereby hold MHC Academy and its representatives harmless in the exercise of this authority. I hereby release MHC Academy, its directors, and representatives from any claims for personal illness or injury that my daughter may sustain during this outing. I further acknowledge that I will be responsible for any medical bills that may be incurred on behalf of my daughter for physical illness or injury that she may sustain during this outing. MHC Academy has rules pertaining to the conduct of all students by which my daughter must abide. My daughter will be responsible for any failure to abide by those rules.*

Answer Required

I am the Parent or Legal Guardian of the student named and give permission to participate in the MHCA Junior Retreat