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Acknowledgement of Family and Student Responsibilities Form

Acknowledgement of Family and Student Responsibilities

In consideration of the attendance and participation of the participant in the Envisioning Youth Empowerment Retreat I/we agree to the following terms and conditions as set forth herein. 

 

Required Items to Bring

  • Comfortable clothing appropriate for the hot summer months.

  • Toiletries (soap, toothpaste/brush, shampoo, etc.)

  • Shoes

  • Pillow and pillowcase

  • Blanket and bed sheets (twin size)

  • Towels and washcloths

  • Spending money (coins and small bills)

Optional Items to Bring

  • Shower shoes

  • Alarm clock

  • Sunglasses

  • Sunscreen

  • Insect repellent

  • Water bottle

  • Closed toe shoes

  • Exercise clothes (there will be daily access to a gym)

  • Sweater or light jacket

  • Technology

  • Backpack / bag

  • Hand sanitizer

Arrival and Departure Information

  • EYE Retreat will be held at The Governor Morehead School located at 301 Ashe Avenue in Raleigh, NC.

  • Early Registration is Saturday, July 27 after 5:00pm.

  • Registration is Sunday, June 28 from 8:30am to 12:30pm.

  • Checkout is Saturday, August 3 from 8:00am to 10:00am. 

  • Late Checkout is not available. 

 

Safety and Emergencies

  • Medical services are not provided during the EYE Retreat.  Refer to the Wavier of Liability and Acknowledgment of Terms for more information on medication procedures and providing medical care if a parent/guardian is unavailable. 

  • You can monitor our website and social media for updates on any safety or emergency situations, such as weather related program changes. 

  • The Governor Morehead School campus is patrolled by the State Capital Police.  A security officer from State Capital Police is available on campus.

  • If the EYE Retreat must be cancelled, delayed, or dismissed early, due to severe weather, such as hurricanes, or other emergency, our goal is to notify families, students, and volunteers as soon as possible. 

  • If you need to contact us during the Envisioning Youth Empowerment (EYE) Retreat, please call (919) 813-0393 day or night.  Alternatively, contact Dr. Alan Chase, Director, at (910) 508-1030.

 

Housing and Food

  • Students and volunteers will be staying in gender specific dorms.  Each dorm room consists of two beds and a shared bathroom. 

  • Roommate requests must be made in advance and are not guaranteed. 

  • Breakfast, lunch, and dinner are provided each day, except dinner on Saturday, July 27 is the responsibility of the family or student. 

  • Some meals may be prepared by or for students as part of a learning opportunity.  

 

Responsible Behavior and Participation

  • At a minimum, attempt to fully participate in all activities.

  • Notify mentors of any concerns, problems, or needs.

  • Make sure that all medications you bring are in the bottle they came in from the pharmacy with your name on the bottle.

  • Be honest at all times.

  • Follow directions of EYE Retreat mentors, presenters, and all other adults.

  • Follow all cleaning procedures in common areas, dorm rooms, bathrooms, and other spaces.

  • Ensure that all dishes and utensils in the kitchen or common areas are cleaned and stored appropriately after each meal. 

  • Ensure that any food brought to the EYE Retreat is kept in common areas or the kitchen, labeled with you name, and kept in a plastic container. 

  • Be conscious of your own safety and that of your peers.

  • Remain in the presence of mentors when away from campus.

  • Dress appropriately for program activities. Dress or clothing that attracts undue or negative attention is not acceptable.  Shoes are required in all areas.

  • Adhere to the assigned schedule of events in a timely manner.

  • Be accountable for the decisions you make regarding your own actions and behaviors.

  • Do not attach or hang any pictures, items, or adhesives to any walls, windows, or doors. 

  • Turn off lights, appliances, or personal items before leaving the room.

 

Specifically Prohibited Behavior

  • Possession, sale, or use of alcohol, tobacco products, or drugs.

  • Possession of weapons of any kind, including all guns, all knives, all explosives, and/or any other implement that could be used as a weapon.

  • Violation of any local, state or federal laws.

  • Failure to sleep in assigned space.

 

Notification and Reimbursement

  • If you are unable to attend the EYE Retreat in whole or in part, notification must be received by June 15.  I/We agree that I/We will reimbursement the EYE Retreat in the amount of $327 if I/We fail to attend the EYE Retreat in whole or in part without proper prior notification.

PARENT SIGNATURE BOX

PARTICIPANT SIGNATURE BOX

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