Editing previous response:

Please fix the highlighted areas below before submitting.

Senior Retreat 2025

Location: Camp Auxilium, Newton NJ

Date: May 21, 2025

Cost: Covered by MHCA

By completeing this form, I permit my daughter to attend the MHC Academy Senior class Retreat. She will travel to Camp Auxilium in Newton, NJ on Wednesday 21, 2025 via MHC Academy school vehicle with Sr. Pamela Rose and Mrs. Borsellino who are serving as chaperones.

Students arrive on campus at 7:00AM for departure at 7:15AM and will return to MHCA between 3:00 PM- 3:30 PM

See below. Students are to dress in casual, appropriate attire. Lunch and snacks will be included.

Student Last Name*

Answer required for "Student Last Name"

Student First Name*

Answer required for "Student First Name"

Parent/Guardian First Name*

Answer required for "Parent/Guardian First Name"

Parent/Guardian Last Name*

Answer required for "Parent/Guardian Last Name"

Parent/Guardian Email Address*

Answer required for "Parent/Guardian Email Address"

Parent/Guardian Phone Number*

Number Required

Emergency Contact Name*

Answer required for "Emergency Contact Name"

Emergency Contact Email*

Answer required for "Emergency Contact Email"

Emergency Contact Phone Number*

Number Required

Important medical information that we should know

Answer required for "Important medical information that we should know"

I hereby authorize MHC Academy, its directors, and representatives to obtain medical treatment for my daughter for any injury or illness during this outing. I hereby hold MHC Academy and its representatives harmless in the exercise of this authority. I hereby release MHC Academy, its directors, and representatives from any claims for personal illness or injury that my daughter may sustain during this outing. I further acknowledge that I will be responsible for any medical bills that may be incurred on behalf of my daughter for physical illness or injury that she may sustain during this outing. MHC Academy has rules pertaining to the conduct of all students by which my daughter must abide. My daughter will be responsible for any failure to abide by those rules.*

Answer required for " I hereby authorize MHC Academy, its directors, and representatives to obtain medical treatment for my daughter for any injury or illness during this outing. I hereby hold MHC Academy and its representatives harmless in the exercise of this authority. I hereby release MHC Academy, its directors, and representatives from any claims for personal illness or injury that my daughter may sustain during this outing. I further acknowledge that I will be responsible for any medical bills that may be incurred on behalf of my daughter for physical illness or injury that she may sustain during this outing. MHC Academy has rules pertaining to the conduct of all students by which my daughter must abide. My daughter will be responsible for any failure to abide by those rules."

I am the Parent or Legal Guardian of the student named and give permission to participate in the MHCA Senior Retreat

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"