Trinity High School Retreat Release Form Trinity High School Registration Parent/Guardian Full Name (required) If you are over 18 and completing this for yourself, type your full name here. Participant First Name (required) Participant Last Name (required) Date of Birth- enter in mm/dd/yyyy format(required) Participant Grade (required) ---9101112N/A Phone Number (required) Address (required) State (required) ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinois IndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvania Rhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code (required) Email (required) Emergency Contact Full Name (required) Emergency Contact Phone Number (required) Any food allergies or special dietary needs? (i.e. gluten free, vegan, dairy free etc.) (required) YesNo Please list food allergies or special dietary needs below: Example: Student is allergic to pineapple. carries epi pen. Any other allergies (outdoor, instects etc.)? (required) YesNo Please list other allergies here: Example: Student is allergic to bee stings. Student needs two benadryl if stung. Any illnesses, injuries or existing medical conditions/restrictions? Example: asthma, diabetic, knee surgery, etc. (required) YesNo Please list recent illnesses/injuries or medicial conditions/restictions below. Example: Student has had knee surgery and cannot run or jump. Student cannot stand for long periods of time. Is the participant up to date on immunizations? (required) YesNoPrefer Not to Answer Additional comments or information you feel we should be aware of: Example: Student does not handle loud noises well. Student will need to not be in an area if loud noises are occuring.