IMPACT Youth Chaperones

CHAPERONE FORM IMPACT RETREAT 2026

Chaperone Agreement Form IMPACT Youth Retreat

Chaperones must understand that by agreeing to be a chaperone they will temporarily be assuming complete responsibility for the youth within their group. Chaperones must be at least 21 years or older and have a current background check. 

Chaperones must be capable of fulfilling all duties required:

1. Be responsible for supervision, management, and discipline of all youth at all times and assist youth to follow directions, including frequent and regular room checks up to and beyond the designated curfew.
2. Always set a good example for youth to emulate. Chaperones specifically agree to abide by the guidelines set forth in Paragraphs 2 to 6, inclusive in the Youth Conduct Form relating to appropriate and inappropriate behavior and language and safe media.
3. Follow ALL emergency procedures and take immediate action in the event of any situation (medical or otherwise).
4. Be positive and enthusiastic to add to the youth’s experience.
5. Chaperones are expected to attend all activities with their group.
6. Dress appropriately. Shorts must be of a modest length, no “short shorts” are allowed. Shirts and t-shirts should not display offensive language or pictures (language and pictures that do not reflect a Christian’s high calling in Christ). Shirts and tops should cover the midriff.
7. For the duration of the trip/event, chaperones are strictly prohibited from: Consuming alcoholic beverages, smoking, using smokeless tobacco and/or vaping, or using controlled/illegal substances.
8. Enforce restrictions, rules, and quiet hours.
9. The “Two Adult” Rule. Our goal is to have at least two chaperones present when interacting with one or more youth, whether at the event, or during some other off-premises activity, event or mentoring program. These adults should not be related.
10. When adults are needed to drive youth to and from the camp every effort should be made to have two adult chaperones with one or more minors as passengers. Avoid having one young person and one adult in the car alone. If you have any unplanned extra stops, attempt to notify parents if possible.
11. Adequate Leader-to-Youth Ratios - Subject to the “two adult” rule minimum, any sponsored youth event should always have a leader-to-youth ratio of no less than one leader to eight youth, particularly if it is outside, near public roads or off-premises. However, the higher the risk, the greater the supervision required. For example, wilderness hiking may require a 1:4 ratio, or if you have any special needs persons in your care. Every effort will be made to have a male and female chaperone and/or leader on every coed event.