Indianapolis Catholic Youth Conference Youth Registration Form

Indianapolis Catholic Youth Conference November 2, 2014

 Youth Registration Form  REGISTRATION Name: ___________________________________________ E-mail: _________________________________ Phone #: __________________Cell Home Address: _________________________________ City: ____________________ State: _____ Zip: ________ Gender: Male Female Date of Birth _____________ Age:_____ T-shirt Size: S M L XL 2XL 3XL Group Leader name:_____________________ Group Leader email:_____________________ Parish attending with: ____________________________ Parish City: ____________________ Diocese: Archdiocese of Indianapolis Grade Level: Freshman Sophomore

Diocese of Lafayette-in-Indiana Junior

Senior

PARTICIPATION CONSENT I grant permission for my child to participate in the Indianapolis Catholic Youth Conference. I will not hold the Archdiocese of Indianapolis, Diocese of Lafayette, or Marian University responsible in the event of any injury or accident to my son or daughter while participating in the conference, and/or traveling to and from the event. I warrant that, to the best of my knowledge, my child is in good health and able to participate in all program activities. (Please submit a statement indicating limitations and/or conditions of which we should be aware.) I agree that my child shall abide by the Youth Code of Conduct.* (see page 2 of registration form). I have reviewed and discussed the Code with my child prior to signing this form. I agree to my child’s participation and agree that if my child fails to abide by the Code or engages in a serious infraction of the Code, he or she may be immediately dismissed from the event with no refund, and sent home at my expense. In case of medical emergency, I understand that every effort will be made to contact parents or guardian of participants. In the event that I cannot be reached, I hereby give permission to the Youth Ministry program directors to seek treatment for my son/daughter. I hereby give permission to the medical staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery for my child. I understand that my child may be photographed, unidentified in group situations; and I hereby grant permission for my child to be photographed & identified for releases to The Criterion and/or Archdiocesan website and/or other promotions. Parent/Guardian (Print): ______________________________________ Parent/Guardian (Signature): ___________________________________ Date:____________________________ Youth (Signature): ____________________________________________ Date: ____________________________ Emergency Contact Name(s): ____________________________________________________________________ Emergency Phone #: _______________________________ Alternate Phone #:___________________________ Health Insurance Company: ___________________________________ Policy #: __________________________ Allergies, medical conditions, dietary restrictions, or special needs: ______________________________________________________________________________________________ ______________________________________________________________________________________________ Parents’ email:__________________________________________________________________________________

Registration Fee: $50.oo* through October 15, 2014. $60.oo after October 15, 2014 *Please note: in order to receive the early registration rate ($50), your registration must be entered online by the Group Leader by October 15, 2014. Please plan accordingly. RETURN THIS FORM TO YOUR PARISH YOUTH MINISTER, CAMPUS MINISTER, OR DESIGNATED PERSON!

ICYC YOUTH CODE OF CONDUCT & EXPECTATIONS*

 Participants are expected to partake in assigned activities and wear their name tags during all program activities.  Dress during the conference is casual. Jeans, T-shirts, etc., are fine. Clothing with offensive or obscene words, pictures, symbols, etc. is not acceptable. Shirts and shoes must be worn at all sessions and meals. No halter tops, tank tops or sleeveless shirts are allowed. Shorts or skirt lengths must be appropriate (when a person is standing straight with arms hanging to side, shorts or skirt must meet or pass their fingertips). Pants must not sag, or a belt will be provided.  Language and conduct should reflect the values we proclaim as Catholics.  Participants are to remain with their group at all times during the conference unless accompanied by adult chaperones. An exception is during MegaSessions and Workshops.  Socializing will take place only in the designated common areas of Marian University.  Smoking and the use of tobacco products is not allowed by any participants during the event. Violation of this rule will result in immediate dismissal from the conference.  The possession or use of alcohol, illegal drugs or weapons will not be tolerated. Breaking this rule will mean immediate dismissal from the event. (Parents will be called.)  Please avoid the use of cell phones/pagers or other electronic devices during the sessions and Mass

You do not need to return this page with your registration…please keep it for your records!