march for life

January 26th-28th in Washington D.C.

Cost: $150

Deadline to Register: January 19th

ITINERARY

Thursday January 26
    9:00am Depart from St. Catharine via Cardinal Transportation Motor Coach
    Stop for lunch
    6pm Arrive to Life is Very Good Youth Rally - George Mason University - 4500 Patriot Circle, Fairfax, VA 22030
    Dinner near the Rally or at the arena concession stands
    10:30pm Check in at Hampton Inn after rally
        10860 Fairfax Boulevard, Fairfax, VA 22030
Friday January 27
    7:00am Wake up and Breakfast at Hotel
    8am Depart for morning rally at George Mason
    11:30am Rally ends, lunch provided at rally by Chick-Fil-a
    Walk to National Mall for March for Life
    1pm March begins
    5pm Return to hotel after March ends
    6pm Dinner
Saturday January 28
    7:00am Wake up and Breakfast at Hotel    
    8:00am Checkout and depart for St. Elizabeth Ann Seton Shrine
        339 South Seton Avenue, Emmitsburg, MD 21727-9297
    10:00am Mass at Seton Shrine
        Tour, etc at shrine
    12:00pm Lunch
    1:00pm Depart for Columbus
    6:00pm Dinner
    10:00pm Arrive back at St. Catharine

Please fill out the following form by January 19th.

If you participated in the Jenkins Mission Trip and gave permission to use that personal information for future Saint Catharine events please e-mail Brendan to gain access to that form.

I. Registration
Name *
Name
Address *
Address
Phone *
Phone
Participant Cell Phone *
Participant Cell Phone
Date of Birth *
Date of Birth
II. Permission
The undersigned hereby state(s) that (he/she/they) (is/are) the (parent/parents/guardian) of the above named Participant and have full legal responsibility for the Participant. The undersigned hereby grant(s) permission for the Participant to participate in the Activity named in Section I.B., above.
III. RELEASE AND INDEMNIFICATION
A. Release. The undersigned on behalf of the undersigned, the Participant, and the heirs, successors and assigns of the undersigned and the Participant, hereby release, hold harmless from any liability, and discharge from all direct or derivative claims, actions, causes of actions, medical expenses, costs, legal expenses, other expenses and all other damages at law or in equity, known or unknown, direct or indirect, choate or inchoate against the Diocese of Columbus, the Parish and all current and former employees, agents, clergy, officers and volunteers of the Diocese of the Parish, arising from the Participant’s participation in the Activity named in Section I.B., above. B. Indemnification. The undersigned shall indemnify and hold harmless the Diocese of Columbus, the Parish, and all current and former employees, agents, clergy, officers and volunteers of the Diocese of Columbus or the Parish from any claim, liability, suit, judgment, loss, damage, expense, fee or cost (including court costs and attorney fees) arising directly or indirectly from the Participant’s participation in the Activity named in Section I.B., above, unless arising from the negligence of an indemnified party.
IV. SPECIFIC MEDICAL INFORMATION AND MEDICATION
A. Specific Medical Information. The Parish will take reasonable care to see that the following information will be held in confidence.
The Participant is taking medication at present. The Participant will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for taking such medications, including dosage and frequency of dosage, are as follows:
Please check one of the following
V. EMERGENCY MEDICAL CONTACT AND TREATMENt
Parent or Guardian *
Parent or Guardian
Phone 1 *
Phone 1
Phone 2
Phone 2
Phone *
Phone
Phone *
Phone
If one or more of your parents are interested in serving as an adult chaperone to Jenkins please check the box below
B. Emergency Medical Treatment
In the event of an emergency, the undersigned hereby give(s) permission to transport the Participant to a hospital for emergency medical or surgical treatment. The undersigned wish(es) to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if the undersigned cannot be reached at the above numbers, contact: *
In the event of an emergency, the undersigned hereby give(s) permission to transport the Participant to a hospital for emergency medical or surgical treatment. The undersigned wish(es) to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if the undersigned cannot be reached at the above numbers, contact:
VI. CONSENT FOR RELEASE OF PERSONALLY IDENTIFIABLE INFORMATION
The undersigned hereby consent to the release of photographs and name of the Participant to be used by the Diocese of Columbus and St. Catharine of Siena for future promotional programs of the Diocese and Parish. If you have any questions or concerns, please contact Brendan O'Rourke at 614-231-4509
VII. CODE OF BEHAVIOR
The Participant shall comply with the following:
1. The Participant must stay and participate in the entire event. The Participant may not leave the premises unless accompanied by an adult leader, parent, or legal guardian. 2. The possession or use of alcohol, tobacco, drugs, or weapons of any kind is not permitted. 3. Foul language is not tolerated. 4. The Participant must comply with any and all directions of activity staff. 5. The Participant must respect the rights and property of others. Damage to or defacing of property will be the financial responsibility of the Participant involved and the undersigned. 6. Failure to abide by this Code of Behavior may result in a request to the undersigned to transport the offending Participant from the premises, and the undersigned shall immediately comply with the request.
VIII. Signatures
Participant's Digital Signature *
Participant's Digital Signature
Date *
Date
Parent or Legal Guardian's Digital Signature *
Parent or Legal Guardian's Digital Signature
Date *
Date
I agree to allow all of the above contained information in Section I, Section IV, and Section V to be used for all future Saint Catharine Youth events for the 2016-2017 academic year. *
Information may be amended. This does not give permission for future events, but simply allows personal, medical, and emergency contact information to be held on file and carried over for the sake of convenience.

If you are paying by cash or check, simply hit submit and you are finished! (payment due by Jan. 19th)

If you want to pay online via St. Catharine's secure online giving site follow the directions below and then CLICK HERE

If you or your family already gives to the parish, simply use their information to login, otherwise you can create your own account. Then follow these steps:

1. Click "Give a New Gift"

2. Under "Youth Group Events" choose "One Time"

3. Enter $150.00 in the Amount space

4. Enter "March" in the Special Intentions space

5. Click "Next" at the bottom of the page

6. Click "Submit"