SERVIO DEO 2020 Participant Registration

May 31 - June 5, 2020 | SERVIO DEO 2020
Mission Trip for current 7th -12th graders | current 6th graders can register if a parent/guardian is able to attend and chaperone.

Join St. Matthew, Holy Family, and St. Philip Catholic Church Youth Ministries to serve the Lord, the Bay St. Louis community, and bond in fellowship.

WHERE: We will be staying at St. Stanislaus College in Bay St. Louis, Mississippi.

TRANSPORTATION: Chaperone vehicles, rental buses and/or charter bus.

COST: $550 ($275 deposit due with registration) See your parish website for more information. If you are unable to pay the nonrefundable deposit amount at this time, please contact your Youth Minister.

DEADLINE TO REGISTER:
April 1, 2020

In order to complete this form, you will need a credit or debit card and a photo or scanned image of your medical insurance card.

For questions about this registration, please contact Deanna Ziesig at deanna.ziesig@holyfamilycc.com
Participant Information

 
Please select one option.
Please select one option.
Select the grade the participant is ENTERING in Fall 2020.
If you are registering a rising 7th grader, please note that one of his/her parents or guardians must be able to attend Servio Deo as a chaperone.
 
 
Enter the best email for family above. To enter more than one, simply separate the addresses with a comma and a space. For example - serviodeo@email.com, serviodeo@email.com
 
Enter the participant's cell phone above, if applicable
Please select one option.
Please select one option.
Please note that the church you select above will be the church used when making transportation assignments.
 
 
Please select one option.
Please select one option.
Parent/Guardian Information

 
 
 
 
Please select one option.
Please select one option.
Medical Insurance and Emergency Contact Information

 
 
 
 
 
 
 
 
Other Participant Health Information

 
 
 
 
Please list any medicine, environmental, and/or food allergies as well as dietary restrictions in the box above.
Please select one option.
 
 
 
 
In the section above, please describe any other considerations that need to be taken into account when placing your child in sleeping quarters and on worksites.  Examples may include, but are not limited to: past traumatic experiences, autism spectrum, issues with bullying/being bullied, anxiety/depression.
 
 
 
 
 
 
 
 
In the box above, please list all medications, dosage, and frequency.
 
Releases and Waivers

Liability Waiver and Medical Release:
I give permission for my child to participate in this mission trip that requires transportation to a location away from the parish site. This activity will take place under the guidance and direction of parish employees and/or volunteers from St. Matthew Catholic Church, Holy Family Catholic Church, and St. Philip Catholic Church. As parent and/or legal guardian, not St. Matthew Catholic Church, Holy Family Catholic Church, St. Philip Catholic Church, the Diocese of Nashville, or those acting as chaperones, retain full legal, physical, and financial responsibility for my child’s personal actions. I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend St. Matthew Catholic Church, Holy Family Catholic Church, St. Philip Catholic Church, Diocese of Nashville, Diocese of Biloxi, Hancock County Resource Center in Mississippi, its officers, directors, agents, employees, or representatives associated with this mission trip from any and all liability claims, loss or damage arising from or in connection with my child’s participation in this mission trip.
In the event of an emergency, I give permission for any medical treatment deemed necessary by the St. Matthew, Holy Family, or St. Philip staff and I also give permission to transport my child to any reasonably accessible hospital or physician’s office. I remain financially responsible for my child’s medical treatment.
 
 
 
 
Media Waiver Release:
I give consent for my child to be in photos and videos used to promote the Diocese of Nashville, St. Matthew Catholic Church, Holy Family Catholic Church, St. Philip Catholic Church, and Catholic faith leaders. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me because of such use.
 
 
 
 
Work Site Preference

Your options for work sites are as follows:
- Work Project - painting, indoor clean up, maintenance, repair work, outdoor yard work.
- Work With Children - work at day care centers for low-income families.
- Work at Social Service Center - homeless shelter, food distribution center, outreach center.

Please select one option.
Please select one option.
Please select one option.
Indicate your level of work experience for the following skills: (Level 1 = no experience, Level 3 = I have done this a few times, Level 5 = very skilled)
Please select one option.
Please select one option.
Please select one option.
Please select one option.
Please select one option.
Please select one option.
 
 
 
 
List medical training, photography, videography, video editing and/or any other areas in which you are skilled in the box above.
 
 
 
 
 
 
 
 
 
 

Description

May 31 - June 5, 2020
SERVIO DEO 2020
Mission Trip for current 7th -12th graders | current 6th graders can register if a parent/guardian is able to attend and chaperone.

Join St. Matthew, Holy Family, and St. Philip Catholic Church Youth Ministries to serve the Lord, the Bay St. Louis community, and bond in fellowship.

WHERE: We will be staying at St. Stanislaus College in Bay St. Louis, Mississippi.

TRANSPORTATION: Chaperone vehicles, rental buses and/or charter bus.

COST: $550 ($275 deposit due with registration) See your parish website for more information. If you are unable to pay the nonrefundable deposit amount at this time, please contact your Youth Minister.

DEADLINE TO REGISTER:
April 1, 2020

In order to complete this form, you will need a credit or debit card and a photo or scanned image of your medical insurance card.

For questions about this registration, please contact Deanna Ziesig at deanna.ziesig@holyfamilycc.com