SERVE: High School Helper Registration – St. Leo the Great Youth Ministry

HIGH SCHOOL HELPER COMMITMENT

High School Helpers have a HUGE positive impact on SERVE 2022. This week you will be serving behind the scenes. You will grow in the following areas:

Faith Formation • Discipleship • Leadership Development • Service

You have the potential to earn service hours by serving this week. You must come with an open heart, a willingness to serve, and a desire to grow closer to our Lord Jesus Christ through the sacraments, service and sacrifice.

Time Commitments

Saturday July 9 @ 9:00am-3:00pm *Mandatory* Leadership Training
Sunday, July 10 @ 2:00pm-8:00pm Set Up & Preparation at St. Leo the Great
Monday July 11 – Wed July 13 @8:30am – 8:30pm SERVE work camp

Location: St. Leo the Great Catholic Church

Attire: Comfortable, modest work clothes (shorts need to be to fingertip length, no tank tops or skin tight clothes, including yoga pants/leggings), sneakers

Bring: A bag lunch (no nuts please), sunscreen, water bottle, basic tools according to site, and a good attitude. Cell Phones and electronic devices, including smart watches (Apple) are NOT allowed, and are grounds for dismissal. We will have a cell phone box to turn in phones at the beginning of each day.

Meals: Breakfast, lunch, dinner, and snacks provided.

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Cell Phone *

Parent/Guardian Work Phone

Relationship to teen?

Mother
Father
Other

RELEASE FORMS

SAFETY *

As the participant, I agree to follow all procedures, safety precautions, and rules and regulations set forth by the Diocese and the Parish.

Signature: *

Print Full Name *

PARENTAL PERMISSION AND LIABILITY RELEASE *

As parent/legal guardian of the participant names above, I give my permission to participate fully in SERVE 2022 at St. Leo the Great on July 10-13, 2022. The meeting time will be The St. Leo Gym on July 10 at 1:00-6:00pm and July 11-13 at 8:30am-8:00pm; pick up time is always 8:00pm. I also give permission for my child to stop at one of the following on “7 Eleven” convenient stores on July 11 for a free slurpees (3910 University Dr. 10140 Fairfax Blvd, or 10485 Fairfax Blvd, Fairfax, VA 22030). I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge Bishop of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above described event.

Signature *

Print Full Name *

INFORMED CONSENT TO MEDICAL TREATMENT *

I request 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. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.

Signature *

Print Full Name *

PHOTO, PRESS, AUDIO, AND ELECTRONIC MEDIA RELEASE *

I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.

Signature *

Print Full Name *

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

RELEASE FORMS

MEDICAL INFORMATION

MEDICATIONS

ALLERGIES

HISTORY

MEDICATIONS

ALLERGIES

HISTORY

MEDICATIONS

ALLERGIES

HISTORY