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Mission Trip 2024 - Catholic Heart Work Camp Richmond, VA June 16-22, 2024

- FORMS
  - Join our parish / Volunteer options
    
    JOIN OUR PARISH
    Sign Up for Weekly Emails
    Ministries/Committees
    Veterans Registration
  - Children-Youth
    
    Faith Formation and TYM Registration Form
    First Communion/ Reconciliation Registration
    Confirmation Registration
    TYM Retreat Permission Slip
    Mission Trip 2024
  - Adult Formation
    
    RCIA Registration Form
    Rejoice Advent Medications Bible Study
  - AUTOMATED GIVING
    
    Automated On-Line Giving
  - Mass/Prayer Requests
    
    PRAYER Requests
    MASS Requests
  - Facilities Requests
    
    Space Request Form

The maximum number of form submissions has been reached. This form is currently not available.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Youth Email REQUIRED Please fill out this field. Please enter an email address.
- Parent Email REQUIRED Please fill out this field. Please enter an email address.
- Youth Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade as of Fall 2024 REQUIRED Please fill out this field.
- Tee Shirt Size REQUIRED Please fill out this field.
- Name Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Email REQUIRED Please fill out this field. Please enter an email address.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Medical Information - Please list all medications taking, allergies, or special medical conditions REQUIRED Please fill out this field.
- Medical Insurance Information - Please provide policy number, Primary Insured, Relationship to Youth, and Insurance Company Phone Number REQUIRED Please fill out this field.
- Your son/daughter is eligible to participate in the following activity that requires transportation to a location away from the parish site. This activity will take place under the guidance of adults from the parish of St. Matthew and adult from other Catholic parishes. A brief description follows:
                  Activity: Catholic HEART Workcamp
                  Location: Richmond, VA
                  Date: June 16-June 22, 2024
                  Method of Transportation: Personal Cars
  In order for your child to participate in this event, please complete and sign the following statement of consent and release of liability, medical information and release form, and contact information. Additional release forms may be required from participating vendors or companies, and will be provided to you prior to the trip for completion and return.
  
  Statement of Consent & Release of Liability
  
  I understand that as a parent/guardian, I remain fully responsible for any liability that may result from personal actions taken by my son/daughter.
  
  If my youth brings or uses any drugs, alcohol, weapons, or tobacco products or engages in reckless or violent behavior, I will be expected to retrieve my son/daughter from the event at my own expenses.
  
  I hereby consent to the participation of my youth in the above-detailed event. I further consent to the conditions stated above regarding participation in this event, including the method of transportation.
  
  I release the Diocese of Raleigh, St. Matthew Catholic Church, and their agents and volunteers from any injuries which may be incurred by my youth.
  
  I give permission for my child, in case of emergency, to be taken to a physician or hospital by either an adult leader, diocesan or parish personnel. I understand that every effort will be made to contact me. If I cannot be reached, however, I hereby give permission to the physician selected by the adult in charge, to hospitalize and secure proper treatment, including surgery, for my son/daughter.
  
  I Agree Please select this field.
- Mission Trip Fee450.0
Total:

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