OR

Permission and Medical Release Form

Each participant (including leaders) completes this form separately for each event or activity involving an overnight stay, travel outside the local area, or higher than
ordinary risks (see General Handbook: Serving in The Church of Jesus Christ of Latter-day Saints, 20.5.5, 20.7.4, 20.7.7). The event or activity leader should have access to all
participants’ forms during the activity.

Event 

St George Utah North Stake Trek 2026

Dates of Event

July 8th thru 11th, 2026

Description of Event and Activities

Pulling Pioneer handcarts aprox 20 miles over 4 days. Sleeping outside. Dancing. Participating in Pioneer games and activities. 

Event or Activity leader

Howard Chamberlain

435 922-1250

Chamberlain.Howard@gmail.com

Stake

St George Utah North Stake

If no, please contact the event or activity leader directly

I give permission for my child or youth (or if signing on my own behalf, as a leader attending this activity, I personally consent) to participate in the event and activities listed above ( unless noted) and authorize the adult leaders supervising this event to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving cecessary medical care.  This authorization shall cover this event and travel to and from this event.

Pease note: Units may not have the ability to meet all medical, physical, and other accommodations and are asked to counsel with parents or guardians on what is possible.

The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp or event safety rules, and other pertinent instructions. (See Attached)  The particpant's conduct and interactionss should abide by Church standards and exemplify Christlike Behavior, including those listed on the attached "Conduct at Church Activities".

Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoded if participants behave inappropriately or if they pose a risk to themselves or others.

This information is collected to help event and activity leaders or medical personnel so they can be prepared and appropriately respond to health concerns or in an emerency.  It will be kept confidential and shared only as needed. 

Conduct at Church Activities
Church events and activities can be fun, uplifting, and spiritually strengthening for
everyone who attends. To reach these aims, all participants are invited to commit
to follow the principles taught in For the Strength of Youth: A Guide for Making
Choices. When you do, the experience will be better for everyone.
Please note that Church activities are not the time or place for romantic behavior
or for conversations and actions that distract from the purpose of the event or
activity.
If you participate in any of the following prohibited activities, leaders at the event
or activity will speak with you, your parents, and your bishop or stake president.
These leaders may decide to send you home immediately.
• Participating in or encouraging immoral behavior of any kind, which includes
breaking the law of chastity or viewing or distributing pornography in any form
• Shoplifting, theft, or vandalism of any kind
• Breaking the Word of Wisdom, including vaping and possessing illegal or harm-
ful substances
• Possessing weapons or dangerous items of any kind (if specifically authorized,
certain items may be provided and used in supervised activities)
• Harming or threatening to harm yourself or others physically, spiritually, or
emotionally, including bullying in any form or disrupting another’s experience
• Leaving without following proper procedures, skipping scheduled activities
without permission, or breaking curfew
Crimes and harmful or destructive incidents or pranks may be reported to local
authorities, who will respond according to local law. Leaders follow the direction of
these authorities.