Permission Form for JUNIOR HIGH WORKCAMP 2017

As the parent/legal guardian of ______permission is hereby given for my child to go on a Parish trip to: Junior High Work Camp 2017 at St. Leo the Great (Destination) on July 9-12, 2017 (Date). The meeting time will be The St. Leo Gym (location) at 8:30am on July 10-12 (time) and the pickup time will be The St. Leo Gym at 8:00pm July 10-12. I understand and acknowledge that participation in the activities involves inherent risks of injury to my child including risks associated with transportation by motor vehicle. I agree to indemnify the Parishes (St. Leo the Great; St. Mary of Sorrows; St. Mark; St. Veronica; St. Paul Chung), Youth Ministers, Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in the activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his or her participation in the activity.

I further give my consent to that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor.

Also, I authorize the Parishes to use my child’s picture or video recording for educational and/or marketing purposes. Parents/guardians who do not wish their child to be photographed or filmed should notify their Coordinator of Youth Ministry in writing. I understand that in the event my child becomes ill with a communicable illness during the trip, I have to make immediate arrangements to retrieve my child from the trip location.

Date of Birth / Date of last Tetanus Booster
Known allergies including any allergies to medicine (Continue on back of form if needed)
Any other medical problems which should be noted (Continue on back of form if needed)
Name of Parent/Guardian
Address / City/State/Zip
Phone Home Work Mobile
Person to notify if parent/guardian is unavailable
Phone Home Work Mobile
Family Physician Phone
Insurance Carrier & Policy Number
Signature of Parent / Date
Signature of Witness / Date
Parent Email Address / Gender / Grade for 2017-18 School Year / Adult T-Shirt Size
Parish


JUNIOR HIGH WORKCAMP 2017

Jr. High Work Camper Participant Commitment:

I hereby make a personal commitment to participate fully in the event described above and to abide by the standards of conduct established by Saint Leo’s Parish and all participating parishes and their representatives.

______

Signature of Participant Date

Parent Involvement Form

This week will be a memorable experience for your child. In order for this camp to happen, your involvement is important! Our biggest need is for Crew Leaders! If you are interested and available to assist as a Crew Leader, please fill out the sheet below.

Name______

Parish: ______Best Phone:______


Email:______

___ Crew Leader (10-15 needed)

-Must attend Crew Leader Training , Sunday July 9, 6:15-8:00pm

-Must be present at entire WorkCamp, July 10-12, 2017

-Must have completed requirements for the OPCYP background check and attend a Safe Environment Training

-Assigned to 4-5 kids making up your crew

-Will drive crew to and from work site and work with them throughout the day

-No experience necessary just desire to work with these kids

How many passengers can your vehicle take? _____

***If you volunteer as a crew leader, your child will be reserved a spot, and you will only need to pay $25 per kid.***

Thank You!

Junior High WorkCamp 2017 cannot be a success without your involvement.

Please return this form to Mrs. Melissa Rihl in the Youth Office at St. Leo the Great.

Please keep for your records!

JUNIOR HIGH WORKCAMP 2017

July 9, 6:15pm-8pm; July 10-12, 8:30 am-8:00 pm

St. Mary of Sorrows Catholic Church St. Mark Catholic Church  St. Leo the Great Catholic Church St. Veronica Catholic ChurchSt. Paul Chung Catholic Church

For: Any rising 7th, 8th, and 9th graders interested in participating in a local service experience.

Location: All activities will begin and end at:

St. Leo the Great Catholic Church

3700 Old Lee Highway

Fairfax, VA

Bring: Comfortable, modest work clothes (shorts need to be to fingertip length, no tank tops), sneakers, a bag lunch, sunscreen, water bottle, basic tools according to site, and a good attitude. No Flip Flops/yoga pants or electronic devices (including cell phones)!

Meals: Breakfast, dinner, and snacks provided.

Please bring your own bag lunch for Monday, Tuesday, and Wednesday.

Fee: $75 for each participant (Checks made out to St. Leo the Great). T-shirt included. Each youth participant must also bring two items from a predetermined list provided below: the boys will choose two items from the Gabriel Project List and the girls will each choose two items from the Homeless Shelter List.

Gabriel Project List: Diapers, Wipes, Travel Size Baby Shampoo/Lotion/Diaper Rash (no baby powder), NEW onesies, bibs, pacifiers, two-piece outfits with NEUTRAL colors.

Homeless Shelter List: Toothbrush/toothpaste, Shaving Cream/Razor, Deodorant, Socks, Granola Bars (no nuts), Hand Sanitizer.

Parents and Youth Must Attend:

Parent and Teen Info Night on Sunday, July 9, 2017 at 6:15pm in the Gym at St. Leo. We will provide pizza for dinner for all participants.

Questions? Contact Melissa Rihl at or 703-591-6089.

Parent Program & Dessert

Wednesday, July 12 at 7:00 pm

Join us for Mass at 6:15pm, followed by dessert and a presentation at 7pm in the Gym at St. Leo.