Welcome
Archbishop
Donate
Search
Search
Search
Search
Search
Toggle navigation
Vocations – Events
Visit to Kenrick-Glennon Seminary
Love's Reply Retreat
Quo Vadis Permission Form
Kenrick-Glennon Days 2023
Kenrick-Glennon Days
Welcome
Archbishop
Donate
Vocations – Events
Visit to Kenrick-Glennon Seminary
Love's Reply Retreat
Quo Vadis Permission Form
Kenrick-Glennon Days 2023
Kenrick-Glennon Days
Our Church
Who We Are
Catholicism Explained
Enflame Our Hearts
Revival
Vocations
Permanent Diaconate
Priestly Vocations
Consecrated Life
Getting Involved
Adult Evangelization
Foster Care Ministry
Prayer Intentions
Outreach & Support
Outreach Ministries
Abuse Survivor
Deaf Ministry
Hispanic Ministry
Marriage & Family Life
Pro-Life Ministry
Retreat Centers
Special Needs
Social Justice
Substantiated Clergy Offenders
Support Services
Annulments – Tribunal
Grief & Loss
Marriage in Crisis
Post Abortion Healing
Unplanned Pregnancy Help
Parishes & Schools
Catholic Parishes
Children’s Catechesis/Religious Ed.
Find Your Parish
Liturgy & Sacramental Life
Parish Business
Catholic Schools
Donate
Archbishop’s Call to Share
One Faith Capital Campaign
Planned Giving
Family & Kids
Families
Catholic Counselors
Catholic Schools
Marriage Enrichment
Resources for Families
Kids/Teens
Camp Tekakwitha
Youth Ministry
Prairie Star Ranch
ReachKCK
Rural Youth Ministry
Totus Tuus
Couples
Engaged Couples
Natural Family Planning
Resources for Couples
Young Adults
Catholic Campus Ministries
City on a Hill St. Paul’s Outreach
Getting Involved
Volunteer Opportunities
Administration
Office of the Archbishop
Offices and Ministries
Human Resources
Media Relations
Report Abuse
Prevent Abuse
Kenrick-Glennon Days
Kenrick-Glennon Days Registration Form
ARCHKCK Registration, Permission & Liability Waiver
General Information
Camper's First and Last Name
(Required)
Date of Birth
(Required)
Street Address
(Required)
City, State and Zip Code
(Required)
Home Parish
(Required)
Grade in School (Fall 2023)
(Required)
Parent(s) Name(s)
(Required)
Parent(s) Phone
(Required)
Parent(s) email address
(Required)
Emergency Contact Name and Phone
(Required)
Is this camper's father or grandfather interested and available to help chaperone this trip?
(Required)
yes
no
Name of chaperone
Health Information
Is this participant in general good health and able to participate in general activities (if not, please explain).
(Required)
Name of camper's physician
(Required)
Physician's phone number
(Required)
Address of physician (street, city, state, zip code)
(Required)
Date of last tetanus booster
(Required)
Is your son presently taking any medications?
(Required)
yes
no
If yes, please list them and provide directions for frequency and dosage.
Will your son be bringing any over the counter medications with him?
(Required)
yes
no
If so, please list them:
Please list any special dietary needs:
Health Insurance Company
(Required)
Health Insurance Policy #
(Required)
Name of Primary Health Insurance Holder
(Required)
Permissions and Liability
Please check all that apply:
(Required)
I hereby certify that the above information is correct and give permission for the release of medical records to an attending physician in case of illness. In case of medical emergency, I understand that every effort will be made to contact parent(s) or guardian(s) of participants. In the event that I cannot be reached, I hereby give permission to the physician selected by the Archdiocese to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child, as named herein.
I request that my son be allowed to participate in, and be transported to and from, Kenrick-Glennon Days at Kenrick-Glennon Seminary in St. Louis, MO. I hereby release and indemnify the Archdiocese of Kansas City in Kansas, its staff, and volunteers from any liability arising from claims of any kind or nature whatsoever from my son's participation in this program.
My son may be given over the counter medication (such as Tylenol, Tums, Advil, cough crops).
During the seminary visit, I give my permission to the Archdiocese of Kansas City in Kansas to take photographs and video of my child to possibly be used for future promotional items.
Parent's Electronic Signature
Today's Date
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
Δ
X