Choose your preferred KAIROS date

166: October 8 - 11 [8 remaining]
Conflicts: In School SAT, Cross Country, Football, and Water Polo
167: November 12 -15 [Join Waitlist]
Conflicts: Water Polo, Basketball, Soccer, Football Section Finals
168: January 28 -31 [8 remaining]
Conflicts: Basketball, Soccer, Wrestling, Mock Trial

Student Name

Student Email

Student Address

Student Mobile Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Student Date of Birth

Student

Student Consent

I agree to attend the date selected. To the best of my knowledge, it does not conflict with my athletic/club/co-curriculars. For my application to be considered complete, I understand I need a code of conduct on file. I will print out the pdf in my confirmation email, fill it out, and drop it off in the Campus Ministry Office.

I, the undersigned, agree to the terms above.

Parent/Guardian

Parent Permission Form and Waiver of Liability and Assumption of Risk Agreement

I, the undersigned parent or legal guardian of the student [listed in student name field]

Attend and participate

Give permission for my child to attend and participate in all activities associated with this retreat. This includes transportation via employee-driven, Jesuit owned or rented van or contracted charter bus supplied by Jesuit High School, to and from the Jesuit Retreat Center of the Sierra in Applegate, California, and sleeping over at the center.

I have read and agree to the terms above.

Health/Medical

Certify that my child has no health problems that would adversely affect his participation in this activity.

Authorize and consent to any medical treatment that may be required in my absence, including x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that the supervising staff deems necessary for the safety and protection of my child. I understand that any costs incurred as a result of illness or injury will be my responsibility.

I also understand that for my son to participate on the Kairos Retreat, he either needs to have proof of a Covid vaccination or a negative Covid test the day before leaving for Kairos.

I have read and agree to the terms above.

Risk

Acknowledge that despite the most careful planning and supervision, serious injuries can occur during the participation in activities or transportation associated with this activity. Mortal or serious personal injuries, property damage, or severe social and economic loss as a consequence of not only their own actions, inactions or negligence, but the actions, inactions or negligence of others, or the condition of equipment used, is possible. There may be other risks not know to me or not reasonable foreseeable at this time.

I have read and agree to the terms above.

Rules Enforcement

Authorize the supervising employees and adult agents of Jesuit High School to enforce the rules outlined in the Jesuit High School Student-Parent Handbook. Any violation of these rules may result in the student being asked to leave Kairos. Should the student be asked to leave, I understand that I will be notified and required to personally travel to him, at my own expense, and escort him home.

I have read and agree to the terms above.

Waiver of Liability

1. Release, waive, discharge and promise not to sue Jesuit High School of Sacramento, its trustees, officers, employees, and agents, from all liability from any and all claims, including the negligence of the school, resulting in personal injury (including death), accidents or illnesses, property loss, and any of the above risks mentioned associated with this activity.

2. I further agree that this Waiver of Liability and Assumption of Risk is intended to be as broad and inclusive as permitted by law, and that if any portion is held invalid the remaining portions will
continue to have full legal force and effect.

3. No student will be permitted to attend/participate unless this form is completed and signed.

I have read and agree to the terms above.

Acknowledgment of Understanding

I have read this Waiver of Liability and Assumption of Risk Agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I confirm that I am signing the agreement freely and voluntarily, and intend my signature to be complete and unconditional release of all liability to the greatest extent allowed by law.

I, the undersigned, agree to the terms above.

Medical/Emergency info

If you choose to use the information on file in FinalForms, please check the box to skip this section

Medical Insurance, Emergency Contacts

Please use my FinalForms info (medical, dietary, emergency contact)
I certify that my child's FinalForms information is up-to-date including any physical or medical problems that the supervising staff should know about (such as allergies) including food allergies, asthma, prescriptions, dietary restrictions, etc.

List of physical or medical problems supervising staff should know of

Medical Insurance Carrier, Group#, Medical Record#

Emergency Contact 1

Emergency Contact 2

Guardian Name

Relationship to student

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Parent/Guardian address is same as student's

Address

Contacts

Parents: Please print a response to all contacts that apply. Choose "not applicable" to skip.

If you have any questions, please call Mr. LeBoeuf at 916-480-2192

Mother

Mother's Name

Mother has same address as student

Mother Address

Mother Mobile Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Father

Father Name

Father has same address as student

Father Address

Father Email

Father Mobile Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Other Parent Figure (ex. Stepparent)

Other Parent Figure 1

Other's Relationship to student

Other 1 has same address as student

Other 1 Address

Other 1 Email

Other 1 Mobile Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Other Parent Figure #2 (ex. Stepparent)

KAIROS APPLICATION

Student

Parent/Guardian

Parent Permission Form and Waiver of Liability and Assumption of Risk Agreement

Medical/Emergency info

Contacts