Health & Liability for Retreat Programs

Congratulations on your decision to participate in a program with SJU Campus Ministry. We are excited to support you in your adventure.

In order to assure that we have the necessary information in case of an emergency, we ask that you please complete the following Medical, Health Insurance, Emergency Contact Information, and Waiver of Claims and Release from Liability. This information will only be shared with the SJU Campus Ministry Director, and Assistant Director.

Participant Information

First Name

Last Name

Banner ID Number

Age

Height

Weight

Sex

	Male
	Female

Address

City, State

Zip

Phone

Insurance Company

Policy Number

Doctor's Name

Phone

Emergency Contact

Relationship to you?

Address

City, State

Zip

Phone

Health & Liability for Retreat Programs

College of Saint Benedict

Saint John’s University