📜 Parent / Guardian Waiver

Youth Spiritual Retreat 2026 • August 20–23 • Shantivan Ashram, Sundridge ON

🙏 🙏 If your child or your family has registered for the Youth Spiritual Retreat 2026, please complete this waiver before camp begins. One waiver covers all your children — you only need to fill this out once per family.

Parent/Guardian Info

Your name, contact info, and home address

Children & Medical

Names, ages, allergies, medications, insurance

Consent & Sign

Five waivers, your digital signature, today’s date

📜 Parent/Guardian Waiver Form

Youth Spiritual Retreat 2026 • August 20–23, 2026 • Shantivan Ashram, Sundridge ON

This waiver must be completed by the parent or legal guardian of each child registered. One waiver covers all your children.

👪 Parent/Guardian Information

Parent/Guardian Name (Primary) *

First

Last

Parent/Guardian Email *

A copy of the signed waiver will be emailed here.

Parent/Guardian Phone *

Second Parent/Guardian Name (optional)

First

Last

Second Parent/Guardian Email (optional)

A copy will also be sent here if provided.

🧒 Children Attending

List the full name and age of each child attending *

One per line. Example: Aarav Sharma, age 14

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

🆘 Emergency Contact

Someone we can reach if we cannot reach you directly.

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Relationship to child(ren) *

e.g., uncle, aunt, family friend

🏥 Medical Information

Please provide accurate information. Leave blank or write "none" if not applicable.

Allergies

Food, medication, environmental (bee stings, pollen). Indicate severity.

Current medications

Name, dosage, time of day. Specify any medications your child will bring.

Medical conditions, dietary restrictions, or special needs

Anything our volunteers should be aware of (asthma, diabetes, vegetarian/vegan, anxiety, etc.).

Health insurance provider

Policy / member number

Family doctor name

First

Last

Family doctor phone

✍ Waiver & Consent

Please read each statement carefully and check the box to indicate your agreement.

1. Liability / Assumption of Risk (required) *

I acknowledge that participation in the Youth Spiritual Retreat involves activities (camping, outdoor recreation, group spiritual practices, food preparation, etc.) that carry inherent risks of injury or illness. I assume full responsibility for my child(ren)'s participation. I release Gayatri Pariwar Western Ontario (GPWO), Shantivan Ashram, their volunteers, organizers, and property owners from any and all liability arising from such participation, except in cases of gross negligence.

2. Medical Emergency Authorization (required) *

In the event of a medical emergency where I cannot be reached, I authorize GPWO staff and volunteers to obtain emergency medical care for my child(ren), including arranging transportation to a medical facility, administering basic first aid, and contacting emergency services. I understand I will be financially responsible for any medical costs incurred.

3. Photo / Video Release (optional - uncheck to decline)

I grant GPWO permission to take photographs and videos of my child(ren) during the retreat for use in promotional materials, social media, the GPWO website, and printed newsletters. No personal identifying information beyond first names will be published.

4. Code of Conduct (required) *

I understand my child(ren) is expected to follow the GPWO Code of Conduct: respect for fellow attendees, volunteers, and the sacred space; abstaining from drugs, alcohol, smoking, and inappropriate language or behaviour; participating respectfully in spiritual activities. Serious or repeated violations may result in my child being removed from the retreat at my expense.

5. Pickup Authorization (required) *

I authorize my child(ren) to be picked up only by myself, by the second parent/guardian named above, or by the additional adults listed below. Photo ID will be checked at pickup.

Additional authorized pickup persons (optional)

Name, phone, and relationship. They will need to present photo ID.

📝 Digital Signature

By typing your full legal name and submitting this form, you affirm that you are the parent or legal guardian of the child(ren) listed, that you have read and understood all sections, and that the information provided is accurate.

Full legal name (digital signature) *

Type your name exactly as you would sign it.

Date *

Form Security Question *

Youth Spiritual Retreat 2026 — Parent/Guardian Waiver

📜 Parent / Guardian Waiver

Parent/Guardian Info

Children & Medical

Consent & Sign

📜 Parent/Guardian Waiver Form

👪 Parent/Guardian Information

🧒 Children Attending

🆘 Emergency Contact

🏥 Medical Information

✍ Waiver & Consent

📝 Digital Signature