Please fill out the form for your student below. If you have multiple students attending, you will be directed to include information for other students later on.
This price includes a student's event ticket, Monday dinner, and lunch and dinner from Tuesday through Thursday. This price does not include breakfast or lodging. Lodging must be purchased separately. After January 13th, the student registration price will go up to $349.
Because of venue policies, any attendee not lodging on campus must pay a $25 event fee.
This price includes one parent event ticket, Monday dinner, and lunch and dinner from Tuesday through Thursday. This price does not include breakfast or lodging. Lodging must be purchased separately. A parent must attend if their child is younger than thirteen.
This section must be filled out by a parent/legal guardian.
Liability Release
As Parent and/or Guardian of the named student, I hereby give my approval for my child’s participation in any and all activities prepared by The Young Writer for the Young Writer Retreat. If there are any activities I wish them to be excluded from, I will record that below. I further agree not to hold the Young Writer, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by my child.
Media Release
As Parent and/or Guardian of the named student, I hereby give my child permission to appear in videos, audio recordings, films, photographs, and on websites and social media sites.
Medical Release
As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Further, as parent or legal guardian, I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child.
Permission is also granted to the Young Writer and its affiliates including Directors, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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