High School Youth Conference February 24-26, 2017 Registration and Information Packet
2017 High School Youth Rally Katie Prejean McGrady Katie Prejean is a teacher, youth minister, author, and speaker from the great (and incredibly humid) state of Louisiana. Since 2007, Katie has been traveling across the country using her unique style of "theological comedy" with audiences ranging in size from 10 to 10,000. Her original blend of humor and story telling along with her teaching of hard-hitting theological truth is dynamic, engaging, and challenging. Katie reads voraciously, blogs occasionally, Tweets & Instagrams regularly, and doesn t like to be hugged. She has her B.A. in Theology from the University of Dallas and is currently working on her Masters in Theology from the Augustine Institute. Her first book, Room 24: Adventures of a New Evangelist was just released from Ave Maria Press. She lives and works in Lake Charles, Louisiana as a 9th grade theology teacher & parish youth director. She married Tommy McGrady in June of 2016. They have an adorable dog, Barney. Tommy McGrady Tommy McGrady is a campus minister, teacher, & speaker originally from Pennsylvania. His dynamic and unique presentation style has inspired teens from Alaska all the way to New York. Tommy s ministry motto is simple: Don t give them a chance to be bored. His inspiring, informative, fun, and engaging presentations show his deep passion for helping people meet and fall in love with Christ. Tommy earned his B.S. in Biology from Eastern University and is currently pursuing his masters in pastoral ministry from Loyola University. Tommy worked as the Coordinator of Youth Ministry for the Diocese of Scranton before moving down to Lake Charles, Louisiana, to serve as the campus minister at St. Louis Catholic High School. He and Katie Prejean married in June 2016. Justin Dery (Music): Justin Dery is a Contemporary Catholic/Christian Artist, Worship Leader, singersongwriter and youth minister. Dery has played with various artists and groups, including nationally recognized Catholic Performers such as, Steve Angrisano, Jesse Manibusan, Anna Scally, and Anne Marie Cribbin. Justin has played at World Youth Day 2008 in Sydney, Australia. Additionally venues include Soulfest, Proud 2B Catholic, and Diocesan Gatherings for the Diocese of Providence and the ArchDiocese of Hartford.
High School Youth Conference 2017 Important Registration Change For those who get their registration packets in on time you will not notice any changes to the process. No registration packet will be considered complete until the entire registration packet has been received (all forms and payment). What does this mean? Your registration packet will not be processed and you will not be registered to attend the conference until we have received the entire registration packet. If you turn in only a portion of your registration packet your packet will be set aside until we receive it in its entirety. That means you may lose out on housing and in some cases even being able to attend. Please note - we understand that you sometimes have to add a youth as a late add-on (please call our office and notify us); this will not create a problem for your whole registration packet. The problem is when a whole group is missing some, or all, of their registration packet. Diocesan Conference Registration 1. Forms -- Please use only the diocesan forms in this packet to register the youth and adults from your parish as they will be the only form of registration accepted by the Youth Office. You may xerox as many copies as needed. Please retain a copy of all forms submitted for your own records. All forms need to be properly completed and returned with payment to the Youth Office by Wednesday, February 1, 2017. Special Notes: There are separate forms for registering and housing youth boys and girls, as well as adult males and females. Please review them carefully before completing. Everyone attending the conference must be registered by his/her parish; using the appropriate form, submit a signed medical release form, and pay the registration fee, including chaperones. The deadline (NO EXCEPTIONS ) for registration at the rate of $105 per participant (youth/adult) is Wednesday, February 1, 2017. We will continue to take registrations until February 15, 2017. Please understand that your registration packet is not considered complete until all forms are submitted and money received. There are no refunds. 2. Housing -- Housing at Camp Kalaqua will be determined by the number of total participants. All diocesan safe environment guidelines for housing will determine how housing is divided among the buildings at the camp. This is only our second year at Camp Kalaqua so please bear with us. 3. Chaperones/Youth -- Please help us put on a great youth conference by ensuring the safety of our young people through adequate supervision. I would like to keep a 7:1 ratio of youth to adults. Please be sure to have adult male and female chaperones,
21 years of age or older and VIRTUS trained. All adults should sit with their young people during all general sessions. Please remember that chaperones are responsible for their youth both day and night. 4. If you have a priest coming with your group, please let us know. Will he need a room? (Please register your priest on the adult housing list.) Will he be participating in any events (ex. Reconciliation/Mass)? Persons under the age of 21 are not considered to be chaperones. They can be a helper, but should not be considered as chaperones. They will be housed as adults. Special Note: It is your responsibility to ensure that your youth understand and follow the diocesan youth conference guidelines. Camp Kulaqua We are excited to continue our new relationship with Camp Kulaqua for our Diocesan High School Youth Conference. For those who have not been to Camp Kulaqua it is located 30 miles northwest of Gainesville off of Hwy 441. The Camp Kulaqua facility offers large hotel-type accommodations and cabins, with a spacious space to allow us to configure the room to ensure that everyone has a good view no matter where they sit! Camp Kulaqua breakout rooms allow us to offer numerous workshops for both youth and adults. The most important aspect is that it is a large, modern facility which allows us to host many people while still comfortably meeting the needs of our group. Registration Forms Enclosed Registration/General Information Materials Packing List Code of Conduct Youth/Adults Emergency Contact Numbers Chaperone Letter First Aid Station Form Workshop Submission Form Registration/Housing Form Priest Attendance Form (Note: For driving directions from your specific location, please use an internet search engine such as maps.google.com: 23400 NW 212 Ave, High Springs, FL 32643) High School Youth Conference General Information Date: February 24-26, 2017
Start Time: End Time: Location: Participants: Friday registration begins at 6:30 p.m. and doors open at 8pm Sunday morning at 11:00 a.m. Camp Kulaqua, High Springs, FL Students in Grades 9-12 may attend Cost: $105.00 per person (youth/adult) Upon Arrival at the Conference Site Registration begins at 6:30 p.m. and doors open at 8:00pm. Upon arrival, you will be directed to parking. Please do not bring your entire group to the registration tables. All participants but the sponsoring adult, including chaperones, should wait in their vehicle until registration is complete. If you have any questions or changes, please report to the trouble-shooting table located in the registration area. Special Note: We will only accept replacements/changes of the same gender. (For example, Johnny gets sick the day of the conference; you may not send Suzy in his place.) There will be absolutely NO room switching without prior written permission from the Director of Youth Ministry. People will be assigned to rooms to help us ensure that there are enough beds for everyone, but more importantly, it is imperative that we know in which room participants will be staying in the event of a nighttime emergency. When you register you will receive an envelope for your group containing: 1) A list of the adults/youth registered from your parish. 2) Name tags for each participant which MUST be worn the entire weekend. Name tags will contain the following information: First and last name, parish, and city. Name tags are $5.00 to replace. 3) A schedule for the weekend. 4) Housing assignments. Packing List Appropriate Casual Clothing, sneakers or athletic shoes (no flip-flops or sandals) Sweatshirts/Jackets Toiletry Items *Towels and linens are provided.
** Do not bring IPods, DVD players, electronic games, or cell phones. At past conferences, we have had several items stolen. Do NOT bring these items to the conference. ** Cell phones are not allowed to be on inside main gathering space. Free Time On Saturday afternoon the youth will be given free time. The youth are invited to participate in several different team sports tournaments; including volleyball, dodge-ball, kickball and basketball. Sign-ups for these sports will take place on Saturday at lunch in the cafeteria. First Aid Station We will again have a first aid station set up in the main gathering space. We are in need of either doctors, nurses, or EMT s who would be willing to help man this station. If you know of someone willing to help, please fill out the enclosed form. Registration is free for those volunteering to assist. Emergency Contact Numbers Please use these numbers only in the event of an emergency! Camp Kulaqua (386) 454-1351 Workshops We are always looking for people to give workshops for the conference. If you or someone you know would like to present a workshop, please fill out and return the enclosed workshop form by February 1, 2017. Extra Money Please let your youth know that speakers/presenters will be selling T-shirts and CD's. Also, we will be taking up a collection for the Diocesan Youth Scholarship fund during Sunday Mass. Rules Please read and review the rules with your adults and youth for the High School Conference 2017 that is enclosed. Thank you!
HSYC 2017 CONFERENCE RULES: 1. Participants are expected to observe Camp Kulaqua rules at all times. Parish group leaders are responsible for the actions of the members of their group. Each parish accepts full responsibility for any damage or theft caused by their members while attending the conference. 2. Adult chaperones in each parish delegation are to help enforce the Code of behavior and set an example for their youth. Camp Kulaqua Staff and The Security Team will be present the entire weekend. Please follow their instruction. 3. Participants must attend all conference activities. All sessions of the conference will start on time. Many sessions require that the doors be closed for all or part of the sessions. To prevent from being excluded from any session, be on time. 4. No weapons, drugs, tobacco products or alcohol may be possessed by any conference participant. Please note: If any of the above are found, in accordance with diocesan policy, the police will be summoned and parents called. 5. There should be no need for sleeping room changes. However, if the need is dire, you must first ask permission of the Diocesan Director. Room assignments were filled in accordance with parish youth leaders preference and due to security and emergency procedures, cannot be changed without good cause and the Diocesan Director s notification. 6. There will be NO visitations in the motel rooms of any kind by members of the opposite sex. Violations will result in dismissal from the conference and your pastor and parents being called. 7. No youth may leave the grounds at any time for any reason---except in the case of a medical emergency and only in the company of an adult chaperone. The Diocesan Director, must be notified of any and all emergency situations. 8. Curfew times are strictly enforced. Everyone is expected to remain in their assigned rooms after curfew each night. 9. As a courtesy to everyone, please dispose of trash in proper containers. Please do not leave litter on the grounds or in the buildings. 10. Prior to check out your motel room must be checked and keys returned. After the closing Sunday, each motel room will be checked for damage, cleanliness, etc. If anything is found to be damaged or missing, your parish will be billed the full extent. I would ask the adult youth leaders check each of their participant s rooms before departure! Please return keys at the end of the youth conference to the place where you were registered. 11. Name tags must be worn at all times. The only exception is during a sporting event. Lost name tags will cost $5.00 to replace. 12. We will have a team of volunteers in charge of security/rules. Any questions or problems can be directed to him.
PRIEST ATTENDANCE FORM - *FREE ADMISSION* HIGH SCHOOL YOUTH CONFERENCE 2017 Name: Parish: Phone: Available for: Mass Reconciliation ----------------------------------------------------------------------------------------------------------------------- FIRST AID STATION - *FREE ADMISSION* HIGH SCHOOL YOUTH CONFERENCE 2017 Name: Parish: Phone: Medical Doctor RN Physician's Assistant EMT
Date: Bishop Felipe J. Estévez Catholic Center 11625 Old St. Augustine Rd. Jacksonville, FL 32258 RE: Chaperones for High School Youth Conference 2017 Dear Bishop Felipe J. Estévez, Our parish youth will be participating in the High School Youth Conference to be held at Camp Kulaqua on February 24-26, 2017. All chaperones attending from our parish have satisfied the VIRTUS requirement under the policy of the USCCB Charter for the Protection of Children and Youth and Level 2 fingerprint criminal background check ( CBC ). Sincerely yours in Christ, Signature of Pastor or Parish Administrator: Parish Name and City: It is the responsibility of the Sponsoring Adult to verify all adult chaperones comply with the diocesan requirements above. Please send a copy of each chaperone s VIRTUS certificate and date of completion for the criminal background check. Please return to the Office of Youth and Young Adult Ministry, 11625 Old St. Augustine Rd. Jacksonville, FL 32258 by February 1, 2017.
WORKSHOP SUBMISSION FORM We are searching for presenters for our High School Youth Conference whose topics are geared towards high school youth. If you would like to present a workshop or know someone who is interested in presenting a workshop, please let us know by completing and returning this form. Workshops should last approximately 50 minutes. Each presenter will be asked to give his/her workshop at least twice. A small stipend will be given for workshop presented. Depending on the number of workshops offered we reserve the right to determine the audience to which the workshop is presented (high school or adult). PROPOSED PRESENTER S CONTACT INFORMATION Name: Address: Telephone: e-mail: PROPOSED WORKSHOP PRESENTATION Topic: Age Group: Brief Summary of Presentation: Present at Camp Kulaqua, High Springs, FL 2/25/2017 Please submit this form to the Office of Youth Ministry no later than February 1, 2017. Everyone who submits a form will be contacted. However, submission of this form does not guarantee that a speaker will be asked to present a workshop.
2017 HIGH SCHOOL YOUTH CONFERENCE YOUTH REGISTRATION FORM FEBRUARY 24-26, 2017 CAMP KULAQUA, HIGH SPRINGS, FL PARISH/SCHOOL: CITY: SPONSORING ADULT: PHONE: (PLEASE PRINT) YOUTH NAME GRADE TELEPHONE MALE/ T-SHIRT SIZE FEMALE Early Bird Registrations Received on or before February 1, 2017 @$105 per person x = total: $ Registrations Received on or after February 2, 2012 @ $125 per person x = total $ Total Youth attending = Please include ONE check payable to: Mail to: Diocese of St. Augustine Office of Youth Ministry 11625 Old St. Augustine Road Jacksonville, FL, 32258 THIS IS THE ONLY REGISTRATION FORM THAT WILL BE ACCEPTED - COPY AS NEEDED.
2017 HIGH SCHOOL YOUTH CONFERENCE ADULT REGISTRATION FORM Please remember proper adult ratios. FEBRUARY 24-26, 2017 CAMP KULAQUA, HIGH SPRINGS, FL PARISH/SCHOOL: CITY: SPONSORING ADULT: PHONE: (PLEASE PRINT) ADULT NAME AGE TELEPHONE MALE/ T-SHIRT SIZE FEMALE Early Bird Registrations Received on or before February 1, 2017 @$105 per person x = total: $ Registrations Received on or after February 2, 2017 @$125 per person x = total $ Total adults attending = Please include ONE check payable to: Mail to: Diocese of St. Augustine Office of Youth Ministry 11625 Old St. Augustine Road Jacksonville, FL 32258 THIS IS THE ONLY REGISTRATION FORM THAT WILL BE ACCEPTED - COPY AS NEEDED.
Diocese of St. Augustine Parent Permission and Release of Liability Parish Field Trip Participation Name of Child: Name of Parent or Legal Guardian: Name of Parish: Name of Event: High School Youth Conference 2017 Destination: Date and Time of Departure: Date and Anticipated Time of Return: Method of Transportation: Cost: The above child is eligible to participate in above parish-sponsored event requiring transportation to a location away from the parish grounds. This activity will take place under the guidance and supervision of employees/volunteers from the above parish. If you would like your child to participate in this event, please read, complete, sign and return this form which includes your consent, as well as a full release of liability. As parent or legal guardian, you remain fully responsible for any acts of the named child during this activity. Please list any known allergies: Physician s Name: Telephone Number: The undersigned parent, guardian or legal representative hereby consents to the participation of the above-noted child in the event described and further consents to the conditions stated above on participating in this event, including the method of transportation. It is understood that this event will take place away from the parish grounds and that the child will be under the supervision of a designated parish employee(s)/volunteers on the stated dates. For and in consideration of the child being allowed to participate in this event, and other valuable consideration, the undersigned parent, guardian or legal representative, on behalf of the child and the child s parents, personal representatives, assigns, heirs, and next of kin, does hereby release and hold harmless the Diocese of St. Augustine, Bishop Felipe J. Estévez, S.T.D, as Bishop of the Diocese of St. Augustine, a corporation sole, Bishop Felipe J. Estévez, S.T.D., individually, the abovenoted parish, and employees and agents of said parties engaged in this particular event, their personal representatives or assigns, from any loss or damage on account of any injury to the person or the personal property, of the child, or death, caused by negligence or otherwise, while the child is engaged in the above-stated event or in transportation to and from said event. The undersigned expressly agrees that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida, and that if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. The undersigned parent, guardian, legal representative further acknowledges that he/she is authorized to enter this Agreement on behalf of the child, and the child s parents, personal representatives, assigns, heirs, and next of kin. (Parent / Guardian / Representative Signature) (Date) Home Phone: Work Phone: Cell Phone: HR 6/2011 (Side A)
Diocese of St. Augustine Parent / Guardian Medical Release High School Youth Conference 2017 Child s Name: Date of Birth: Parent / Guardian Name: Home Address: Home Phone: MEDICAL MATTERS: 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. (Of the following statements pertaining to medical matters, sign only in accordance with your wishes.) EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I hereby give permission to Diocese of St. Augustine s employees, volunteers, or representatives to seek medical treatment for my child above named. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize, secure proper treatment for, and to order injection and / or anesthesia and / or surgery for my child above named. In the event of an emergency, if you are unable to reach me at the above number, contact: Name and Relationship: Family Doctor: Family Health Plan Carrier: Phone: Phone: Policy Number: I make the following exception: My Child s Medications / Dosages: Medication: Dosage: Doctor: Medical Problem or Condition (allergies, diabetes): Condition: Symptoms: Physical Disabilities: Signature of Parent / Guardian Date OTHER MEDICAL TREATMENT: In the event it comes to the attention of the Diocese of St. Augustine s employees, volunteers or representatives that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, I hereby give permission for over-the-counter medication to be administered to my child according to directions. Signature of Parent / Guardian Date HR 7/2008 (Side B)
Diocese of Saint Augustine Catholic Center 11625 Old St. Augustine Road Jacksonville, Florida 32258 (904) 262-3200 Child Photography Release Form Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs. Child s Name (Printed): Parent or Guardian Signature: Address: City: State: Zip: Telephone: Cell: Email: Date:
ADULT RELEASE OF LIABILITY AND MEDICAL INFORMATION Diocese of Saint Augustine I,, for and in consideration of being permitted to (print your name) participate in the program on (print name of activity, event, etc.),20 on my behalf and that of my personal representatives, assigns, (print date or date range of event) heirs, and next of kin, do hereby release and hold harmless, the Diocese of Saint Augustine, Felipe J. Estévez, as Bishop of the Diocese of Saint Augustine, a corporation sole, Bishop Felipe J. Estévez, individually, all organizers of this program and this event, all volunteers, chaperones, employees and agents of said parties and, their personal representatives or assigns, for any loss or damage on account of any injury to the person or personal property of myself, or death, caused by negligence of the released parties or otherwise, while I am engaged in the above stated program, any of its activities, or transportation to and from the above noted program or activities of the program. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of State of Florida, and that if any provision of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. In the event of any emergency, which requires medical or other attention, I hereby give permission to the release parties for myself to be transported to a hospital or like facility for emergency medical, dental, anesthetic or surgical treatment. I further agree to pay for any and all expenses incurred with respect to the emergency and such treatment. WITNESS DATE SIGNATURE DATE MEDICAL INFORMATION Name: Birth date: Address: City: FL Zip: Home Phone ( ) - Cell Phone ( ) - In case of emergency, notify: Name: Phone: ( ) - Relationship: Name: Phone: ( ) - Relationship: Name of Family Doctor: Telephone No.: ( ) - Do you have insurance: Yes or No (Attach copy of insurance card) Company: Insurance Policy No.: List Current Medications/Dosages List Current Medical Conditions/Symptoms List allergies/reactions/emergency treatment Date of Last Tetanus Shot Rev. April 2013
Diocese of Saint Augustine Catholic Center 11625 Old St. Augustine Road Jacksonville, Florida 32258 (904) 262-3200 Adult Photography Release Form Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs taken of me. These photographs may be used for news and editorial purposes in publications, electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs. Name (Printed): Signature: Address: City: State: Zip: Telephone: Cell: Email: Date: (Side B)
DIOCESAN HIGH SCHOOL YOUTH CONFERENCE CAMP KULAQUA, HIGH SPRINGS, FLORIDA FEBRUARY 24-26, 2017 HOUSING LIST - YOUTH BOYS Parish/School: CONTACT PERSON: City: Phone: NOTE: ALL YOUTH ROOMS SLEEP FOUR (5). PLEASE WRITE LEGIBLY. SPECIAL ROOM NEEDS... EXPLAIN NEEDS **PLEASE NOTE WE RESERVE THE RIGHT TO COMBINE PARISHES IF ALL THE BEDS ARE NOT USED.**
DIOCESAN HIGH SCHOOL YOUTH CONFERENCE CAMP KULAQUA, HIGH SPRINGS, FLORIDA FEBRUARY 24-26, 2017 HOUSING LIST - YOUTH GIRLS Parish/School: CONTACT PERSON: City: Phone: NOTE: ALL YOUTH ROOMS SLEEP FOUR (5). PLEASE WRITE LEGIBLY. SPECIAL ROOM NEEDS... EXPLAIN NEEDS **PLEASE NOTE WE RESERVE THE RIGHT TO COMBINE PARISHES IF ALL THE BEDS ARE NOT USED.**
DIOCESAN HIGH SCHOOL YOUTH CONFERENCE CAMP KULAQUA, HIGH SPRINGS, FLORIDA FEBRUARY 24-26, 2017 HOUSING LIST - ADULT FEMALES Parish/School: City: CONTACT PERSON: Phone: NOTE: ALL ADULT ROOMS SLEEP MINIMUM THREE (3) UP TO FOUR (4). PLEASE WRITE LEGIBLY. SPECIAL ROOM NEEDS... EXPLAIN NEEDS **PLEASE NOTE WE RESERVE THE RIGHT TO COMBINE PARISHES IF ALL THE BEDS ARE NOT USED.**
Parish/School: CONTACT PERSON: NOTE: DIOCESAN HIGH SCHOOL YOUTH CONFERENCE CAMP KULAQUA, HIGH SPRINGS, FLORIDA FEBRUARY 24-26, 2017 HOUSING LIST - ADULT MALES ALL ADULT ROOMS SLEEP MINIMUM THREE(3) UP TO FOUR (4). PLEASE WRITE LEGIBLY. City: Phone: SPECIAL ROOM NEEDS... EXPLAIN NEEDS **PLEASE NOTE WE RESERVE THE RIGHT TO COMBINE PARISHES IF ALL THE BEDS ARE NOT USED.**