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Steubenville NYC 2019 - St. Rose of Lima Parish

Save my spot to the Steubenville Youth Conference – July 19 - 21, 2019 and Liability Form

Important Information:

Registration is open to St. Rose of Lima Teens currently in grades 8-12.

January 15th –
Registration Opens Online: Pay Non-refundable Deposit to Reserve Spots

May 1st – Deadline for Dropping Spots, Final Balance Due, All paperwork due!

June 1st – Deadline for Storm Cards - Virtus class must be completed by over 18 teens.

 

Registration Information & Cancellation Policies

We will be adhering to the below registration and cancellation policies to allow as many people as possible the opportunity to experience Steubenville NYC. Please be sure to read all the information thoroughly.

Pricing/Payment Info -

NOTE:  YOU WILL RECEIVE AN EMAIL COPY OF YOUR REGISTRATION.  PLEASE PRINT YOUR COMPLETED REGISTRATION AND TURN IN WITH PAYMENT.  IF YOU DO NOT RECEIVE AN EMAIL PLEASE LET US KNOW.


Summary of Costs

o Early Bird Cost: $300

o Cost after May 1: $315

o Deposit Amount: $50

o Deadline for Payment of Final Balance (to receive Early Bird rate): May 1st


Checks should be made out to St. Rose Church (note: Steubenville 2019 on check) and mailed with a printed copy of your registration (confirmation email) to:

St. Rose of Lima parish 

ATTN: Steubenville NYC

46 Church Hill Rd.

Newtown, CT 06470

Payments can also be brought to Youth group, or dropped off at the Rectory Office.

Final balance payments must be received in the offices by May 1st, 2019 in order to receive the early bird pricing. After that date, the increased pricing will be applied.
 

Cancellation Policies

Deposits are non-refundable.

• If cancelled, the $50 deposit will be forfeited, but the remaining balance will not be owed if spots are dropped before May 1st. 

Families will be held responsible for payment in full for all spots not dropped by May 1st.
 

Important Information

Youth participants must be age 18 or younger and incoming freshman through just graduated seniors.

Any student who turns 18 prior to the Conference must complete a Virtus (Protecting God’s Children) training class and background check prior to June 1st or immediately upon turning 18 prior to the conference.  Class schedule can be found on the church website.

 

Financial Assistance and Fundraising

  • Requests for financial assistance should be addressed in writing to our Youth Minister,  Renzo Ortega,  who will submit to Msgr. Weiss for review.
  • All participants are expected to participate in our fundraising efforts.  These efforts will be aimed at registration for adult chaperones to attend as well as to provide assistance to families who have been approved for assistance.

 

Fill out this online Conference Commitment Form to reserve your spot today!

This form does not complete the full registration process however, all paperwork and online assignments will be sent for completion after May 1st, 2019.

 

Travel Schedule:  Drop Off July 19 from 9am with Pick Up July 21st at approx. 3pm.

This page will be emailed to you for your records and to reference important dates!

2019 Steubenville NYC Youth Conference Commitment Form

1. Student Participant Information *This question is required.
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This question requires a valid email address.
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The undersigned do hereby request and consent that my child listed above attend and participate in the activity and associated activities listed above.  I authorize an adult, in whose care the minor has been entrusted, to render supervision and to provide consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician, dentist or emergency medical technician licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or treatment center whether such diagnosis or treatment is rendered at the office of said physician or said hospital or treatment center.

The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this request and authorization.

Diocese of Bridgeport Medication Self-administration Policy:

Youth will be expected to carry and self-administer any properly prescribed medication, both prescription or non-prescription, during the trip. Youth must make their chaperones aware of such medication; however, chaperones will not be responsible for or expected to administer or carry such medication. Youth are expected to know when and how to administer such medication and must act accordingly regarding such self-administration. The parents/guardians of any youth administering medication hereby indemnifies and holds harmless the Diocese of Bridgeport, its employees, volunteers, agents or other representatives for any and all claims, actions, damages or injuries, including death, that may arise as a result of this policy.

 

If circumstances arise that cause my minor child to be prescribed medication while on the trip, my child is hereby authorized to carry and administer such medication as needed and the same guidelines and indemnification will apply.

The undersigned does also hereby give permission for my child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in the above activity sponsored by St. Rose of Lima Parish.

I give permission to St. Rose of Lima Parish and the Diocese of Bridgeport to photograph videotape and/or film my child and to use his or her image in photographs, video, and/or film for the purpose of promoting the mission, activities, and any programs.  I understand that I, and my child are not entitled to any compensation or rights in these materials, and I release St. Rose of Lima Parish and the Diocese of Bridgeport or any of its agents from any liability for the use of my child’s image for the above stated purposes.

PARENT /GUARDIAN REQUEST AND RELEASE OF ALL CLAIMS


In consideration for being accepted by St. Rose of Lima Parish and the Diocese of Bridgeport for attendance at and participation in the above-listed activity and associated activities, on behalf of my child participant (if under the age of 18), I the parent/guardian listed in this form, hereby assume all risk of personal injury, sickness, death, damage, expense as a result of participation in all activities involved therein.

The undersigned further hereby agree to hold harmless, and indemnify said Parish and Diocese, its directors, employees, agents and adult volunteers, for any liability sustained as a result of the negligent, willful, or intentional acts of said participant, including expenses incurred attendant thereto.


I, thereby request participation and grant permission for above mentioned child to participate fully in said activity, and hereby give my permission to accompanying chaperones to supervise, care, and discipline my child.

Further, should it be necessary for the participant to return home due to medical reason, disciplinary action or otherwise, I assume all transportation costs.  When travel to, and from the activity is not parish sponsored, I assume all liabilities for any personal injury, damage and expense incurred as a result of riding in or driving any vehicle to and from said activity.

9. I, parent or guardian of the minor listed in this form agree to the conditions in the text within this liability form and my name below indicates my electronic signature of acceptance.   *This question is required.
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11. Mother Information
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12. Father Information
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PARTICIPANT ONLY

I have read the foregoing and itinerary addendums or attachments, if applicable, and understand the rules of conduct and will abide by them, as well as the directions of the leadership of the activity.  I understand that my participation in said activity can be ended at any time at the discretion of activity leaders.

13.

I, agree to the conditions in the text within this liability form and my name below indicates my electronic signature of acceptance.

*This question is required.
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Signature of
This question requires a valid date format of MM/DD/YYYY.
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