2018 PEAK REGISTRATION- 18+ Echoes of Worth
Details
Location: Portola, CA
Address: 108 Taylor Ave, Portola, CA 96122
Contact Name: Andrew Brown
Dates: Friday, June 1 - Sunday, June 3

A Camping & hiking weekend with other young adults while studying bits and pieces of "Love & Responsibility" as put forth by St. John Paul II.
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Email *
First Name *
Last Name *
Home Address *
E-mail Address *
Gender *
Shirt size *
Parish Name *
Medical plan name *
Policy number *
Medical plan address *
Medical plan telephone *
Doctor's name *
Doctor's telephone *
Emergency contact name *
Emergency contact telephone *
What's your familiarity with Theology of the Body? *
How would you rate your camping/hiking skills? *
At what level do you expect the PEAK hikes to be: *
I plan to be ready to hike/camp (arrival time): *
I hold the parish and Diocese of San Jose harmless from any claim of injury, sickness, illness or damage that I may  suffer or sustain during the ACTIVITY listed above, with exception to injury of damages arising out of the sole negligence of the parish or Diocese of San Jose. I attest that I am physically fit to participate in this event.In the event that I become ill or injured, I do hereby consent to whatever x-ray, examination, medical or treatment and hospital care are considered necessary in the best judgement of the attending physician and performed by or under the supervision of a member of the medical staff of the hospital facility providing the treatment. I am not aware of any medical condition which would render it inappropriate for me to participate in any such activity. *
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PICTURES ARE TAKEN FOR MINISTRY EVENTS AND GATHERINGS.  WE WOULD LIKE TO BE ABLE TO USE THESE PHOTOGRAPHS FOR NEWSLETTERS, FLYERS, AND THE ECHOES OF WORTH WEBSITE. WE WILL NOT USE ANY LAST NAMES IF POSTED.  CONCERNS ABOUT PUBLISHED PICTURES SHOULD BE EXPRESSED TO WRITER/ WEBMASTER AND WILL BE PROMPTLY DEALT WITH.  I AUTHORIZE AND GIVE FULL CONSENT, WITHOUT LIMITATION OR RESERVATION, TO THE ECHOES OF WORTH TEAM TO PUBLISH ANY PHOTOGRAPHS IN WHICH THE ABOVE NAMED PARTICIPANT AND/OR PICTURES APPEARS WHILE PARTICIPATING IN ANY PROGRAM WITH ECHOES OF WORTH.  NO COMPENSATION IS TO BE GIVEN. *
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Are there any known allergies to food that we should be aware of? If yes, please explain.  If no, please leave blank.
Do you have any known allergies to medications that we should be aware of? If yes, please explain.  If no, please leave blank.
Do you have any special dietary needs?  If yes please list.
Do you have any known physical, psychological or emotional limitations that would affect your participation in this event?
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