SJY STEUBENVILLE PILGRIMAGE ORLANDO, FL 2018 TEEN REGISTRATION PACKET

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1 SJY STEUBENVILLE PILGRIMAGE ORLANDO, FL 2018 TEEN REGISTRATION PACKET Item Page Instructions...1 Schedule and Costs (including other information)...2 Fundraising and Financial Aid Information... 3 SJY Summer Pilgrimage Participant Registration and Medical Information Form...4 SJY Parent/Guardian Consent, Indemnity and Emergency Medical Agreement Form...5 Participant Supplemental Information Form...6 Participant Financial Aid Application Form...7 INSTRUCTIONS Please fill out all forms completely, unless you do NOT request financial aid, in which case that form is not required to be returned. The following items MUST be turned in with the completed packet: (1) A copy of the front and back of your health insurance card; (2) $ NON-REFUNDABLE deposit, a space will not be reserved for you without deposit. (3) Steubenville Conference form must have original signed sheet not faxed or scanned. (When available) (4) A current photograph of each person attending the conference before departure. If one is not provided, we will take a photo at an SJY meeting or contact you to provide one by . If you have any questions or concerns please contact: Gina Bauer Senior High Youth Director gina.bauer@churchofstjoseph.org 1

2 SCHEDULE & COSTS A more detailed Itinerary will be available for reference closer to the time of the pilgrimage Event: Departure: Return: Cost: Includes: Steubenville Orlando, FL (July 27-29th) Tuesday July 24, 2018 Thursday August 2, 2018 $ for registered parishioners of the Church of St. Joseph $ for non-parishioners -Bus transportation to and from Orlando, FL. -Steubenville Conference fee and SJY conference T-shirt -Two nights at Shingle Creek Convention Center -Ocean/beach trip and sunset -Hotel and/or church/ school accommodations for other nights -Admission to Universal Studios if possible -Some additional meals Payment Schedule: Because the Church of St. Joseph must commit substantial non-refundable amounts well in advance of the conference, the following payment schedule is required to ensure adequate stewardship of parish funds. Registered Item Date Due Parishioner Non-Parishioner Application Fee (non-refundable) With Application $ $ Balance of First Half Payment (*) March 15 $ $ Second Half (Final) Payment (**) May 25 $ $ TOTAL May 25 $ $ **Deposits are not refundable. Cancellations made prior to May 25, 2018 are refundable, except for $ ($ deposit + $100.00). Cancellations made after May 25 th, 2018 are not refundable, due to contractual obligations connected to the pilgrimage. Invoices will reflect participation in fundraising events. Please make checks payable to the Church of St. Joseph and with Steubenville 2018 in the memo section.

3 Fundraising: Financial Aid: Italian Benefit dinner and a Raffle are scheduled through late April. Thanks to the generosity of anonymous benefactors and fundraising activities, limited funds are available to reduce the cost of the trip for those with financial need. All financial aid requests will be decided by parish staff after May 5, 2018, based on the accompanying form and private discussions with those in need. The amount of any financial aid will be reflected in the final invoice issued in mid-may. SJY may require participation in fundraising activities as a condition of awarding financial aid. Communications: Raffle Sales: By submitting your application with addresses and cell phone numbers, you agree that SJY and the Church of St. Joseph may contact the participant and their parent/guardian by and/or text message regarding the pilgrimage and other related SJY events. Raffle ticket proceeds are used to reduce the cost of the trip. Each youth is required to sell a minimum of 10 raffle tickets. By signing below, you agree that you are responsible for selling the above stated number of raffle tickets, or you may opt out of selling the tickets and be charged $100 extra as either a parishioner or non-parishioner. Participant Name Date Parent / Guardian Signature (Must be signed) Please check here pilgrimage rates. if opting out of raffle ticket sales and paying higher This form MUST be completed and returned.

4 Participant Registration Participant Name Grade and age (at time of conference) ( )M ( ) F Street Address Date of Birth City/State/Zip Cell Phone (Mom) (Dad) Youth Cell Phone Youth Parent Address (required) Parish: Church of St. Joseph (check box if registered parishioner) OR Parish Name City Allergies Other Medical Conditions Medications/Prescriptions Health Insurance Participant Medical Information Plan Number Group Number Doctor Name Doctor Phone In consideration of my child s participation, I agree to indemnify the Church of St. Joseph parish/school and the Archdiocese of St. Paul/Minneapolis (including their agents) from any claims or law suits brought against the parish/school/archdiocese of St. Paul/Minneapolis (including their agents) by myself, my child, or others, that arises out of any behavior by my child at the event/activity described above. I also agree to pay reasonable attorney s fees or expenses incurred by the parish/school/archdiocese (including their agents) in defense of such a claim/law suit. If photographs or videos of my child are taken, I give my permission for the use of my child s image and/or likeness in any promotional or other marketing activities relating to the Church of St. Joseph. Parent/Guardian Signature Date Print Parent/Guardian Name

5 Participant Name Parent/Guardian Name Parent/Guardian Home Phone Parent/Guardian Cell Phone Parent/Guardian Address SJY STEUBENVILLE PILGRIMAGE - Orlando, Florida Parent/Guardian Consent, Indemnity and Emergency Medical Agreement I grant permission for the Participant named above to participate in the SJY 2017 Pilgrimage, and I warrant that my child is in good health. In consideration of my teen s participation, I agree to indemnify the Church of St. Joseph parish/school and the Archdiocese of St. Paul/Minneapolis (including their agents) from any claims or law suits brought against the parish/school/archdiocese of St. Paul/Minneapolis (including their agents) by myself, my child, or others, that arises out of any behavior by my teen at the event/activity described above. I also agree to pay reasonable attorney s fees or expenses incurred by the parish/school/archdiocese (including their agents) in defense of such a claim/law suit. Emergency Medical Instructions In the event of an emergency, I give my permission for the Participant to be transported to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of an emergency, if you are unable to reach me at the above numbers, contact one of the following: Contact Name Work Phone Home Phone Cell Phone Contact Name Work Phone Home Phone Cell Phone Parent/Guardian Signature Date Print Parent/Guardian Name Parent/Guardian MUST complete the Steubenville Conference form when available.

6 Additional Participant Information Print Participant Name: T-Shirt Size Small Medium Large X-Large (circle one) List up to 3 friends you would like to room with during the conference (you will be with at least one of your choices) Is this your first Steubenville Conference trip? Yes No If not, list up to three of the most recent conference(s) you attended (years or locations) Is there anything you want the group leaders to know as you make the trip?

7 Participant Financial Aid Request Participant Name: Financial Aid will be determined by SJY staff and conversations with teens and parents as necessary. Please answer the following to help us consider your request. 1. Briefly describe why you need financial aid. 2. What fundraising efforts have you already made? How much have you raised? 3. Briefly describe the amount and type of your participation in SJY the past year. 4. Are you a registered parishioner at St. Joseph s?

The College of Science, Engineering, and Technology

The College of Science, Engineering, and Technology Health and Science Summer Academy APPLICATION JUNE 25TH JULY 20TH 2018 * MONDAY FRIDAY * 9:00AM 4:00PM I. APPLICANT INFORMATION (PLEASE PRINT CLEARLY OR TYPE) Name [Last] [First] [MI] Birth Date / / Mailing