Register for the Freshman Retreat

To register for the Freshman Retreat, submit the following form:

• YOU MUST BE ACCEPTED FOR ADMISSION AND DEPOSIT PAID to attend the retreat.
• More information will be e-mailed to you at the email address you provide below.
• ATHLETES: Please check your pre-season practice schedule before registering.
• If you have any questions or need further info, contact Penny Rice at 704-637-4188.

Your Information

First Name *

Last Name *

Preferred Name *

Catawba Student ID # *

E-mail *

Phone *

Address *

City *

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Zip *

Parent/Guardian Information

Full Name *

E-mail *

Phone *

Emergency Contact Information

In case of emergency, please contact:

Name *

Relation *

Phone # *

In addition to the name above, what other driver(s) may participant be released to in the event of emergency?

Retreat Information

Will you need transportation to Black Lake Center? *YesNo

T-Shirt Size *SMLXLXXL

Retreat Date (Full retreats not listed) *July 28-30August 10-13

Special dietary or physical accommodations needed:

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Healthcare Information

Name of Primary Care Physician *

Phone # for Primary Care Physician *

Any allergies to drugs, foods, plants, insects, etc.

Any prescription medication (and dosage) taken by the Participant

Any medical conditions relevant to participating in retreat activities (i.e. surgeries; serious injuries; chronic or recurring illness; conditions such as epilepsy or diabetes; mental illness, etc.)

Upload a photo of your insurance card below (JPG, PDF, DOC, PNG formats only) *Select File

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Acknowledgement

If the Participant is under the age of 18, a parent/guardian must initial below demonstrating that they have read and hereby consent to allow Participant to participate in the activities of the Catawba Freshman Retreat. By entering your initials, you consent to attending the Catawba Freshman Retreat to be held at the Black Lake Retreat Center, organized by Catawba College in 2020. Accordingly, you agree to the following:

1. Behavior. The Catawba Freshman Retreat is designed for participants to bond and prepare for the upcoming transition into campus life at Catawba College. Pursuant to that goal, the staff at the Catawba Freshman Retreat expect participants to respect staff members, to follow camp rules and procedures (to be overviewed on the first day), to respect the property of Black Lake Retreat Center, and to value all other participants.
2. Transportation. If field trips are part of the Catawba Freshman Retreat, then they will encompass off campus activities. Field trips may include, but are not limited to, swimming, canoeing, kayaking, hiking, and/or ropes courses as well as transportation to and from those sites. I consent to transportation to and from any activities and I understand that staff will exercise reasonable care during field trips.
3. Emergency Care. I understand that Catawba Freshman Retreat staff are not licensed medical professionals, but that they will make their best efforts to provide reasonable first aid care in the event of a minor injury, such as a small cut or scrape, and I authorize them to do so. However, in the event of a more serious accident or illness during the retreat that needs immediate treatment, I agree to receiving first aid & medical treatment from qualified practitioners, including life-saving treatments, as may be considered necessary by a licensed medial provider. I authorize any necessary transportation (without notice to parent/guardian, if not practical), by ambulance if necessary, to the nearest available medical facility. I understand the extent & limitations of my medical insurance and that it is primary, unless otherwise specified. I will inform the staff immediately if there is any change in medical circumstances (including changes to insurance coverage) from the date signed below through the conclusion of Freshman Retreats. In the event of an emergency, a staff member will contact the parent/guardian and/or the emergency contact as soon as is reasonably possible.
4. Image Release. Catawba Freshman Retreat staff will be taking photographs throughout the retreat. I hereby give consent to Catawba College to use my image and likeness in its promotional publications, advertising, videos or other media activities (including the Internet). Further, I acknowledge that I will not receive compensation for such uses.
5. Technology Policy. I acknowledge that Participant assumes the risk of theft or loss for any electronic device(s), including cell phones, that Participant elects to bring to Freshman Retreats and under no circumstances will Freshman Retreat staff be held liable for damage to electronic devices. Further, I agree to respect any rules that Catawba Freshman Retreat staff set regarding times or appropriate uses of electronic devices.
6. Liability Limitation. Parent/Guardian and/or Participant hereby releases and agrees to hold harmless, Catawba College and Black Lake Retreat Center, or any of their respective affiliated entities, from any and all liability for any harm or damages incurred by Participant arising out of the Freshman Retreat program. Any legal dispute arising out of the Freshman Retreat Program will be governed by the laws of North Carolina and all parties hereto consent to the exclusive jurisdiction of Rowan County, North Carolina to resolve any such matter.

BY ENTERING YOUR INITIALS BELOW, YOU ARE AGREEING TO THE TERMS STATED HEREIN AND ACKNOWLEDGING THAT ALL INFORMATION PROVIDED ON THE ABOVE REGISTRAION AND HEALTH PROVIDER INFORMATION FORMS IS ACCURATE.

Initials of Participant *

Initials of Parent/Guardian (required if participant under 18)

Agreement to Attend

In registering, you are reserving a spot at the Freshman Retreat. If you do not attend after registering, a $50.00 charge will be placed on your student account.

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