EFC Adult Registration

Participant Contact Information

Your Name:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Email:

Your Phone Number:

Emergency Contact Information

Emergency Contact Name:

First

Last

Emergency Contact Email:

Emergency Phone Number:

Emergency Contact Relationship to You:

General Information

Your Primary Church:

Event Information (June 2026 Extreme Faith Camp)

Description of Event: EFC & Preparations: meetings, team building/fundraising, and other related events
Date of Event: 01/01/26 – 8/15/26
Transportation Method: Carpool 6/08/26 – 6/12/26
Participant cost: $475 per participant
Sponsored by: Immaculate Conception Church & St. Patrick Church
Supervised by: Karen LaBossiere and volunteer chaperones

Participant Information Section

Date of Birth:

Gender:

T-Shirt Size

Special Needs (Medical, Learning Disabilities, Physical Disabilities, etc.):

Participation Permission

I acknowlege my signature below indicates the following:

In accordance with the United States Conference of Catholic Bishops’ Charter for the Protection of Children and Young People AND the Diocese of Superior Safe Environment requirements, I have completed all of the appropriate documentation required to accompany minors on this event specified above.
I agree to act in accordance with the Diocesan Code of Conduct for Working with Minors, Diocesan Morals & Ethics Policy, Diocesan Chaperone Guidelines, and the directives established for this specific event.
I fully understand my responsibilities for this event as described to me by parish/school/diocesan staff and/or those planning this activity.
I further agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Immaculate Conception & St. Patrick, New Richmond, the Diocese of Superior, its officers, directors, agents, employees, or representatives associated with the event specified above from any and all liability claims, loss or damage arising from or in connection with my participation in this activity.
I agree to inform event organizers of any special concerns or needs I may have.

Signature

Clear Signature

Primary Physician

First

Last

Physician Phone Number:

Health System & Location

Health Insurance Carrier

Policy Number

Required Forms

Please upload any necessary medical forms below.

Registration: Consent Health

Do you need to submit a Medication Consent Form?

Yes

If you selected “Yes”, you need to submit a Medication Consent Form. Please download the form here, fill out the form digitally and upload the completed form on the next page. Please include your name within the saved form’s filename.

Form Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Please be sure that the youth’s name is contained within the file name.

Photo, Video & Likeness Policy

Effective July 1, 2025, our policy for the use of photos, video recordings, and other likenesses at all church functions has gone into effect. Please view it here.

Required Acknowledgement

Yes

acknowledge that I have read through all policies and filled out the appropriate information to register the youth in this submission for the ICSP sponsored EFC trip.

Name of person acknowledging above:

ICSP Payment Section

The cost per registrant is $475 for the trip, with $100 deposit due with registration. Financial scholarships are available; the request can be made here.

Payment Type:

Total Non-Refundable Deposit Due for Registration:

Price is in Dollars (USD)

Name of Person Filling Out This Form:

Registration Submission

Your registration is incomplete until you click on the “Submit” button below, and you receive a confirmation on your screen.

SATURDAY	5:00 PM
SUNDAY	9:00 AM

TUESDAY	5:00 PM
WEDNESDAY	10:00 AM	8:15 AM Non-School Year
THURSDAY	8:15 AM
FRIDAY	8:15 AM

Participant Contact Information

Emergency Contact Information

General Information

Event Information (June 2026 Extreme Faith Camp)

Participant Information Section

Required Forms

ICSP Payment Section

IMPORTANT NOTICE TO ONLINE PAYERS:

Make your payment online:

Make your payment to the ICSP Business Office:

Registration Submission