DYC2027

Saint Bede Youth Ministry DYC 2027 Registration Form

Please complete the registration form by December 18. Registration forms received after this date will be placed on a waitlist. Once a trip reaches capacity, additional registrants will also be added to the waitlist.

One registration form is required per teen. A $100 deposit per trip is required to reserve a spot.

Scholarships are available for families in need. No teen will be turned away due to financial circumstances.

Trip Eligibility:
• Diocesan Youth Conference: currently in 8th grade to 12th grade

Youth Information

DYC REQUIRED DYC February 19-21 Please fill out this field.

Name REQUIRED Please fill out this field. Please enter valid data.

First Name for Badge REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Grade (2026-2027) REQUIRED Please fill out this field. Please enter valid data.

Sex REQUIRED Please fill out this field.

Birthday REQUIRED Please fill out this field. Please enter valid data.

Adult tshirt size REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Information

Parent 1 Name REQUIRED Please fill out this field. Please enter valid data.

Parent 1 Cell phone REQUIRED Please fill out this field. Please enter valid data.

Parent 1 email REQUIRED Please fill out this field. Please enter valid data.

Parent 2 Name Please enter valid data.

Parent 2 Cell phone Please enter valid data.

Parent 2 email Please enter valid data.

Emergency Contact Information

In the event of an emergency, parents will always be contacted first. Please list someone else in case parents cannot be reached.

Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

Relationship to participant REQUIRED Please fill out this field. Please enter valid data.

Medical Information and Release Form
All information is kept private and confidential.
In many cases, our staff and chaperones are not familiar with the medical, physical, and/or emotional history of each participant. Please share ANY information relating to the participant in detail. PLEASE BE AS SPECIFIC AS POSSIBLE.

Does the participant have any dietary restrictions?

Select any restrictions that apply to this participant: Gluten-free Peanut-free Vegetarian Dairy-Free

Is the participant Allergic to anything?

List any details of allergies below (This may include food allergies, specific medications or chemicals, allergies to any substance, etc.) Please enter valid data.

Is the participant currently taking or has taken any prescription medication in the last 6 months?

List the specific prescription medications, reasons for medication and daily dosage. indicate if the medication is currently being administered. Please enter valid data.

Does the participant have any emotional, physical or sensory conditions?

List any emotional conditions that may impact participation in summer trip. This may include counseling, treatment for emotional conditions (i.e. depression, eating disorders), and/or family situations that may have significant impact to the participant. Please enter valid data.

List any physical and/or sensory conditions of which we should be aware or of which need speical accommodations (e.g. hearing loss, visual impairment, mobility). Please enter valid data.

Please list and explain any other pertinent information to help staff navigate the emotional and physical well being of your teen.

Permission to give Over the Counter medications

If it should become necessary, I hereby give permission to administer medication to Saint Bede Staff, Summer Trip first aid staff the following non-prescription medications.

List of medication. Please indicate the medication you give permission to administer Tylenol Antacid (tums) Sudafed Benadryl (for allergies) Ibuprofen Antibiotic Ointment Hydrocortisone Cream Poison Ivy topical treatment (calamine) Aspirin

My child will be bringing the following medications with hi/her: (please list the medication name and instructions for use.)

Parent signature (type name please) Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Release of Liability and Medical Release

As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend the Catholic Diocese of Richmond, its employees and agents, chaperons, or representatives associated with the event from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the Diocese, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese. I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers I give permission for the noted emergency contact to be notified. I will not hold the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.

Parent signature (type name please) Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Use of Pictures and/or Video

I give permission for pictures and/or videos of the above-named participant engaged in activities related to any diocesan event to be used in publications, social media, and/or websites of the Diocese of Richmond. If there is a concern with this policy, please contact the Office for Evangelization upon submitting registration.

Please select

Parent signature (type name please) Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

YOUTH CODE OF CONDUCT

Youth participants must read, understand, agree, sign, and return this sheet with the Medical Information and Release form. Each participant is expected to adhere to the following principles while at Diocesan Youth Conference

SHOW LOVE AND RESPECT FOR GOD:
 Pray daily for self and others.
 Participate in opportunities to receive the Sacraments.
 Participate in the sessions, activities, and prayer experiences.
 Be open, flexible, and have a servant’s attitude.
 Represent God in your words and actions.

SHOW LOVE AND RESPECT FOR SELF:
 Remember that you are the Temple of the Holy Spirit. Present yourself accordingly.
 No alcohol, drugs, or smoking will be tolerated.
 Dress with modesty. Bare mid-drifts, spaghetti straps, short-shorts, and low cut tops are not permitted; shirts are to be worn at all times.
 Any music you bring and listen to should glorify God.
 Drink plenty of water, obey sleeping times, and make sure you eat all meals. This will allow you to fully participate and not be tired.
 If you must leave an activity, adult chaperones should accompany you since they are responsible for you.

SHOW LOVE AND RESPECT FOR OTHERS:
 All words and actions should be those of Christ to build up others and not injure.
 Make sure that your actions during the activities do not distract others from hearing, seeing, or praying.
 Be safe. No horseplay or other potentially harmful actions. Leave pocketknives, lighters, or other hazardous materials at home.
 No teenagers are allowed to drive directly to or from the event due to limited parking and liabilities.
 Under no circumstances can a youth be in the room or hall of a member of the opposite sex.  Allow others to sleep. “Lights Out” means that it is time to go to sleep. Do not be in the showers or halls after “Lights Out”.
 No outside or unregistered visitors at the event will be permitted.
 The facility must remain clean and undamaged. Otherwise, you will personally be responsible to pay for the damage. Don’t bring food or drinks to the rooms and pick up trash if you see it.

OTHER INFORMATION:
 Any damages caused by the participant will be charged to the participant.

I have read, understand, and agree to the above principles. Any violation of the above principles may result in immediate dismissal from the Diocesan Work Camp and participants will forfeit their registration fee.

Youth signature (type name please) Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Parent signature (type name please) Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.