Middle School Youth Rally October 17, 2015

Middle School Youth Rally October 17, 2015 Registration and Information Packet

2015 Middle School Youth Rally October 17, 2015 Bishop Snyder High School, Jacksonville Keynote Presenters: Apex Ministries APeX Ministries (aka Gene and Brad) is an internationally known comedy duo based out of Brooklyn, NY and Aurora, CO. Since 1996 they have traveled North America using a style they define as Christian Vaudeville. This includes death defying juggling, sketch comedy, and personal testimony. In other words, they are evangelists, they throw things at each other, and they are funny. Gene hopes one day to compete in the Olympics as a solo synchronized swimmer. Brad is very strong! Music: ACT1V8 Youth Ministry Band is a collaboration of musicians from both the adult and youth contemporary bands at Our Lady Star of the Sea Catholic Parish in Ponte Vedra Beach, FL. We are driven by our common love of Jesus Christ. We passionately strive to bring God's people closer to Him through the power of song.

Middle School Youth Rally 2015 Important Registration Change For those who get their registration packets in on time, you will not notice any changes to the process. No registration packet will be considered complete until the complete registration packet has been received (all forms and payment). What does this mean? Your registration packet will not be processed and you will not be registered to attend the youth rally until we have received the entire registration packet. If you turn in only a portion of your registration packet, then your packet will be set aside until we receive the entire completed registration packet. (Please note - I understand that you sometimes have to add a youth as a late add-on (please call our office and notify us). That will not create a problem for your whole registration packet. The problem is when a whole group is missing some or all of the registration packet. Youth Rally Registration 1. Forms -- Please use only the diocesan forms provided to register the youth and adults from your parish as they will be the only form of registration accepted by the Youth Office. You may xerox as many copies as needed. Please retain a copy of all forms submitted for your own records. All forms need to be properly completed and returned with payment to the Youth Office by Thursday, October 1, 2015. Note: Everyone attending the Youth Rally must be registered by his/her parish; using the appropriate forms, and pay the registration fee, including chaperones. The deadline (NO EXCEPTIONS ) for early bird registration at the rate of $20.00 per participant (youth) and $10.00 (adult) is Thursday, October 1, 2015. Beginning Friday, October 2, 2015, the registration fee will be $35.00 per participant (youth) and $15.00 (adult) and the final registration deadline is Friday, October 9, 2015. Any additions to your registration roster received after the early bird deadline will be at the higher rate. Please understand that your registration packet is not considered complete until all forms are submitted and money received. There are no refunds. 2. Chaperones/Youth -- Please help us put on a great youth rally by ensuring the safety of our young people through adequate supervision. I would like to keep a 7:1 ratio of youth to adults. Please be sure to have adult male and female chaperones, 21 years of age or older, VIRTUS trained and CBC (Criminal Background Check). All adults should sit with their young people during all general sessions. Please remember that chaperones are responsible for their youth. Persons under the age of 21 are not considered to be chaperones. They can be a helper, but should not be considered as chaperones. 1

3. All Drivers Drivers must be at least 25 years of age. They must have proof of auto insurance with limits of 100-300-50 when they are using personal or diocesan owned vehicles to transport children. All drivers should have completed the Diocesan Driver Information From (available from the parish secretary or business manager, or Human Resources (904)262-3200 ext. 119), and have the form, photocopy of insurance card, and driver s license on file at the church. Special Note: It is your responsibility to ensure that your youth understand and follow the diocesan youth rally guidelines. Registration Forms Enclosed Youth Registration Form Parent Permission & Release of Liability Form Parental/Guardian Medical Release Form Child Photography Release Form Priest Attendance/First Aid Volunteer Form Adult Registration Form Adult Release of Liability & Medical Form Adult Photography Release Form Chaperone Letter Workshop Submission Forms Note: For driving directions from your specific location, please use an internet search engine such as maps.google.com: Bishop John J. Snyder High School, 5001 Samaritan Way, Jacksonville, FL 32210. Youth Rally General Information Date: October 17, 2015 Start Time: Check-In begins at 9:45 a.m. and ends at 10:15 a.m. End Time: 5:00 p.m. Location: Bishop John J. Snyder High School Participants: Students in Grades 6-8 may attend Cost: Early Bird Registration before October 1, 2015, $20.00 per each youth participant and $10.00 per each adult participant. After this date the cost will be $35.00 per each youth participant and $15.00 per each adult participant. Registration Deadline is October 9, 2015. Scholarship Information There are a limited number of scholarships available on a first come, first serve basis. 2

Upon Arrival at the Youth Rally Site Registration begins at 9:45 a.m. and ends at 10:15 a.m. in front of the Gym. Please do not bring your entire group to the registration tables. All participants but the sponsoring adult, including chaperones, should wait in their vehicle until registration is complete. If you have any questions or changes, please report to the trouble-shooting table located in the registration area. When you register, you will receive an envelope for your group containing: 1) A list of the adults/youth registered from your parish. 2) Name tags for each participant which MUST be worn the entire day and will contain the following information: First and last name, parish, and city. 3) A schedule for the day. Workshops We are always looking for people to give workshops for the conference. If you or someone you know would like to present a workshop, please fill out and return the enclosed workshop form by October 1, 2015. Extra Money Please let your youth know that speakers/presenters will be selling T-shirts and CD's. Rules Please read and review the rules with your adults and youth for Youth Rally 2015 that is enclosed. Thank you! 3

Middle School Youth Rally RULES: 1. Participants are expected to observe Youth Rally rules at all times. Parish group leaders are responsible for the actions of the members of their group. Each parish accepts full responsibility for any damage or theft caused by their members while attending the conference. 2. Adult chaperones in each parish delegation are to help enforce the Code of behavior and set an example for their youth. Volunteers will be present the entire day. Please follow their instruction. 3. Participants must attend all conference activities. All sessions of the conference will start on time. Many sessions require that the doors be closed for all or part of the sessions. To prevent from being excluded from any session, be on time. 4. No weapons, drugs, tobacco products or alcohol may be possessed by any conference participant. Please note: If any of the above are found, in accordance with diocesan policy, the police will be summoned and parents called. 5. No youth should leave the grounds except in the case of a medical emergency and only in the company of an adult chaperone. Mike Sylvester, Diocesan Director, must be notified of any and all emergency situations. 6. As a courtesy to everyone, please dispose of trash in proper containers. Please do not leave litter on the grounds or in the buildings. 7. Name tags must be worn at all times. 4

PRIEST ATTENDANCE FORM - *FREE ADMISSION* MIDDLE SCHOOL YOUTH RALLY 2015 Name: Parish: Phone: Lunch: Turkey Ham Veggie Available for: Mass ----------------------------------------------------------------------------------------------------------------------- FIRST AID STATION - *FREE ADMISSION* MIDDLE SCHOOL YOUTH RALLY 2015 Name: Parish: Phone: Medical Doctor RN Physician's Assistant EMT Lunch: Turkey Ham Veggie

Date: Bishop Felipe J. Estévez Catholic Center 11625 Old St. Augustine Rd. Jacksonville, FL 32258 RE: Chaperones for Middle School Youth Rally 2015 Dear Bishop Felipe J. Estévez, Our parish youth will be participating in the Youth Rally to be held at Bishop Snyder High School on October 17, 2015. All chaperones attending from our parish have satisfied the VIRTUS requirement under the policy of the USCCB Charter for the Protection of Children and Youth and Level 2 fingerprint criminal background check ( CBC ). Sincerely yours in Christ, Signature of Pastor or Parish Administrator: Parish Name and City: Please return to the Office of Youth and Young Adult Ministry, 11625 Old St. Augustine Rd. Jacksonville, FL 32258 by October 1, 2015.

WORKSHOP SUBMISSION FORM We are searching for presenters for our Middle School Youth Rally whose topics are geared towards middle school youth. If you would like to present a workshop or know someone who is interested in presenting a workshop, please let us know by completing and returning this form. Workshops should last approximately 50 minutes. Each presenter will be asked to give his/her workshop at least twice. A small stipend will be given for workshop presented. Depending on the number of workshops offered we reserve the right to determine the audience to which the workshop is presented (middle school or adult). PROPOSED PRESENTER S CONTACT INFORMATION Name: Address: Telephone: e-mail: PROPOSED WORKSHOP PRESENTATION Topic: Age Group: Brief Summary of Presentation: Present at Bishop Snyder High School, Jacksonville 10/17/2015 Please submit this form to the Office of Youth Ministry no later than October 1, 2015. Everyone who submits a form will be contacted. However, submission of this form does not guarantee that a speaker will be asked to present a workshop.

2015 MIDDLE SCHOOL YOUTH RALLY YOUTH REGISTRATION FORM PARISH/SCHOOL: CITY: SPONSORING ADULT: PHONE: PLEASE CHECK RALLY ATTENDING: OCTOBER 17 BISHOP SNYDER HIGH SCHOOL, JACKSONVILLE, FL (PLEASE PRINT) YOUTH NAME GRADE TELEPHONE MALE/ MEAL FEMALE (TURKEY, HAM, VEG.) Early Bird Registrations Received on or before October 1, 2015 @$20 per person x = total: $ Registrations Received on or after October 2, 2015 @ $35 per person x = total $ Total Youth attending = Please include ONE check payable to: Mail to: Diocese of St. Augustine Office of Youth Ministry 11625 Old St. Augustine Road Jacksonville, FL, 32258 THIS IS THE ONLY REGISTRATION FORM THAT WILL BE ACCEPTED - COPY AS NEEDED.

2015 MIDDLE SCHOOL YOUTH RALLY ADULT REGISTRATION FORM Please remember proper adult ratios. PARISH/SCHOOL: CITY: SPONSORING ADULT: PHONE: PLEASE CHECK RALLY ATTENDING: OCTOBER 17 BISHOP SNYDER HIGH SCHOOL, JACKSONVILLE, FL (PLEASE PRINT) ADULT NAME AGE TELEPHONE MALE/ MEAL FEMALE (TURKEY, HAM, VEG.) Early Bird Registrations Received on or before October 1, 2015 @$10 per person x = total: $ Registrations Received on or after October 2, 2015 @$15 per person x = total $ Total adults attending = Please include ONE check payable to: Mail to: Diocese of St. Augustine Office of Youth Ministry 11625 Old St. Augustine Road Jacksonville, FL 32258 THIS IS THE ONLY REGISTRATION FORM THAT WILL BE ACCEPTED - COPY AS NEEDED.

Diocese of St. Augustine Parent Permission and Release of Liability Parish Field Trip Participation Name of Child: Name of Parent or Legal Guardian: Name of Parish: Name of Event: Middle School Youth Rally 2015 Destination: Date and Time of Departure: Date and Anticipated Time of Return: Method of Transportation: Cost: The above child is eligible to participate in above parish-sponsored event requiring transportation to a location away from the parish grounds. This activity will take place under the guidance and supervision of employees/volunteers from the above parish. If you would like your child to participate in this event, please read, complete, sign and return this form which includes your consent, as well as a full release of liability. As parent or legal guardian, you remain fully responsible for any acts of the named child during this activity. Please list any known allergies: Physician s Name: Telephone Number: The undersigned parent, guardian or legal representative hereby consents to the participation of the above-noted child in the event described and further consents to the conditions stated above on participating in this event, including the method of transportation. It is understood that this event will take place away from the parish grounds and that the child will be under the supervision of a designated parish employee(s)/volunteers on the stated dates. For and in consideration of the child being allowed to participate in this event, and other valuable consideration, the undersigned parent, guardian or legal representative, on behalf of the child and the child s parents, personal representatives, assigns, heirs, and next of kin, does hereby release and hold harmless the Diocese of St. Augustine, Bishop Felipe J. Estévez, S.T.D, as Bishop of the Diocese of St. Augustine, a corporation sole, Bishop Felipe J. Estévez, S.T.D., individually, the abovenoted parish, and employees and agents of said parties engaged in this particular event, their personal representatives or assigns, from any loss or damage on account of any injury to the person or the personal property, of the child, or death, caused by negligence or otherwise, while the child is engaged in the above-stated event or in transportation to and from said event. The undersigned expressly agrees that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida, and that if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The undersigned parent, guardian, legal representative further acknowledges that he/she is authorized to enter this Agreement on behalf of the child, and the child s parents, personal representatives, assigns, heirs, and next of kin. (Parent / Guardian / Representative Signature) (Date) Home Phone: Work Phone: Cell Phone: HR 6/2011 (Side A)

Diocese of St. Augustine Parent / Guardian Medical Release Middle School Youth Rally 2015 Child s Name: Date of Birth: Parent / Guardian Name: Home Address: Home Phone: MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.) EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to Diocese of St. Augustine s employees, volunteers, or representatives to seek medical treatment for my child above named. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and to order injection and / or anesthesia and / or surgery for my child above named. In the event of an emergency, if you are unable to reach me at the above number, contact: Name and Relationship: Family Doctor: Family Health Plan Carrier: Phone: Phone: Policy Number: I make the following exception: My Child s Medications / Dosages: Medication: Dosage: Doctor: Medical Problem or Condition (allergies, diabetes): Condition: Symptoms: Physical Disabilities: Signature of Parent / Guardian Date OTHER MEDICAL TREATMENT: In the event it comes to the attention of the Diocese of St. Augustine s employees, volunteers or representatives that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, I hereby give permission for over-the-counter medication to be administered to my child according to directions. Signature of Parent / Guardian Date HR 7/2008 (Side B)

Diocese of Saint Augustine Catholic Center 11625 Old St. Augustine Road Jacksonville, Florida 32258 (904) 262-3200 Child Photography Release Form Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs. Child s Name (Printed): Parent or Guardian Signature: Address: City: State: Zip: Telephone: Cell: Email: Date:

ADULT RELEASE OF LIABILITY AND MEDICAL INFORMATION Diocese of Saint Augustine I,, for and in consideration of being permitted to (print your name) participate in the program on (print name of activity, event, etc.),20 on my behalf and that of my personal representatives, assigns, (print date or date range of event) heirs, and next of kin, do hereby release and hold harmless, the Diocese of Saint Augustine, Felipe J. Estévez, as Bishop of the Diocese of Saint Augustine, a corporation sole, Bishop Felipe J. Estévez, individually, all organizers of this program and this event, all volunteers, chaperones, employees and agents of said parties and, their personal representatives or assigns, for any loss or damage on account of any injury to the person or personal property of myself, or death, caused by negligence of the released parties or otherwise, while I am engaged in the above stated program, any of its activities, or transportation to and from the above noted program or activities of the program. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of State of Florida, and that if any provision of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. In the event of any emergency, which requires medical or other attention, I hereby give permission to the release parties for myself to be transported to a hospital or like facility for emergency medical, dental, anesthetic or surgical treatment. I further agree to pay for any and all expenses incurred with respect to the emergency and such treatment. WITNESS DATE SIGNATURE DATE MEDICAL INFORMATION Name: Birth date: Address: City: FL Zip: Home Phone ( ) - Cell Phone ( ) - In case of emergency, notify: Name: Phone: ( ) - Relationship: Name: Phone: ( ) - Relationship: Name of Family Doctor: Telephone No.: ( ) - Do you have insurance: Yes or No (Attach copy of insurance card) Company: Insurance Policy No.: List Current Medications/Dosages List Current Medical Conditions/Symptoms List allergies/reactions/emergency treatment Date of Last Tetanus Shot Rev. April 2013

Diocese of Saint Augustine Catholic Center 11625 Old St. Augustine Road Jacksonville, Florida 32258 (904) 262-3200 Adult Photography Release Form Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs taken of me. These photographs may be used for news and editorial purposes in publications, electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs. Name (Printed): Signature: Address: City: State: Zip: Telephone: Cell: Email: Date: (Side B)

Middle School Youth Rally 2015 Parish Checklist Parish Name: Parish City Adult Sponsor: Contact Phone: Date Registration Received: Fees: Early Bird Registration before October 1, 2015 $ # of Adults @ $10.00 $ # of Youth @ $20.00 # of Middle School (Grade 7-8) Youth Registration October 2 thru 9, 2015 $ # of Adults @ $15.00 $ # of Youth @ $35.00 # of Middle School (Grade 7-8) Youth $ Amount Paid Check # Forms: Youth Registration Form Parent Permission and Release of Liability Form (Side A) Parental/Guardian Medical Release Form (Side B) Child Photography Release Form Adult Registration Form Adult Release of Liability and Medical Information (Side A) Adult Photography Release Form (Side B) Chaperone Letter Priest Attendance/First Aid Volunteer Form (optional) Workshop Submission Forms (optional) Notes: