Sophomore & Junior Visit Day- Hwy 10 Bus Trip

Holistic Emergency Preparedness Day at Concordia College - Moorhead

This scenario contains sensitive material, including a motor vehicle accident and the negative impacts of drug use. The content will not be overly graphic (comparable to a PG-13 rating or milder). If this topic may be challenging for your student, please reach out to their teacher to discuss alternative options for the day.

First Name*

Preferred Name

Last Name*

Preferred Pronouns

Email Address*

Birthdate*

Mailing Address*

Country

Street

City

Region

Postal Code

Name of Current School*

High School Graduation Year

hidden school ceeb

What is your major area of interest? (Ctrl + to select multiple)

Extra-curricular/Academic Achievements

Emergency Contact Name

Emergency Contact Phone Number

Visit Details

Please select a pick up location:

Maple Grove, MN

St. Cloud, MN

Please select a pick up location:

Brainerd, MN

Staples-Motley High School

Perham High School

How many guests will be attending the visit with you?

0 (student only)

1 (student and guest)

I Release Concordia College and the Sanford Heimarck Simulation Program (CCSP) from liability in participation of any activity that I am present for on the premises AND AGREE TO THE FOLLOWING:

Uphold the integrity and confidentiality about the details of the scenarios and performance of any participants – adhering to HIPPAA and FERPA guidelines.
Protect intellectual property of the school, the staff, and the constituents thereof.**
Respect CCSP’s property and will take responsibility for any damages I may incur while present.
Allow the CCSP to photograph or record my experience for educational purposes as well as use any data collected for IRB approved educational research, new faculty training and/or quality improvement purposes. I will not be compensated for the use of my likeness.

**agreeing to this includes that I will not take unauthorized photography or video of the experience

I Release Concordia College and the Sanford Heimarck Simulation Program (CCSP) from liability in participation of any activity that I am present for on the premises AND AGREE TO THE FOLLOWING:

Uphold the integrity and confidentiality about the details of the scenarios and performance of any participants – adhering to HIPPAA and FERPA guidelines.
Protect intellectual property of the school, the staff, and the constituents thereof.**
Respect CCSP’s property and will take responsibility for any damages I may incur while present.
Allow the CCSP to photograph or record my experience for educational purposes as well as use any data collected for IRB approved educational research, new faculty training and/or quality improvement purposes. I will not be compensated for the use of my likeness.

**agreeing to this includes that I will not take unauthorized photography or video of the experience

I agree

By participating in this event, attendees assume all risks associated with the activities and release Concordia College - Moorhead from any liability for injuries, damages, or losses. Attendees consent to necessary medical treatment in case of an emergency and are responsible for any related costs. They agree to follow all safety rules and understand that failure to do so may result in removal from the event. Additionally, attendees grant permission for photographs and videos taken during the event to be used by Concordia College - Moorhead for promotional and marketing purposes without compensation.

I Agree

We’re looking for girls who really want to grow and explore how to create positive impact in the world. You don’t need to have dreams of owning a business, but need to be ready to discover new dimensions of yourself through a high impact, fun, and personalized retreat. Please submit a personal narrative or essay that convinces us why you are the right fit for this retreat. You could tell us a story, a dream or goal you have, or examples that highlight your fit. Word limit - 400 words.

Are you interested in learning more about receiving a scholarship to attend this event?

Did someone nominate you? Please enter their name here.

If you have any visit requests, dietary restrictions, or accessibility accommodations, please indicate so here: