1. As the parent or guardian of the participant stated above, in signing this form, I hereby state that the information included in this form is correct and give permission for my child to participate in the 2022 Steubenville Conference.
2. I understand that my child will be under the supervision of the staff and volunteers.
3. It is understood that all possible caution will be taken by those persons in charge to keep everyone safe and to prevent injuries, but neither the chaperones, other teens, the Office of Youth Ministry staff, nor Assumption will be held responsible in the case of an accident or injury.
4. In the case of a medical emergency, I understand that every effort will be made to contact me, but in the event that I cannot be reached, I hereby give permission for my child to be evaluated, diagnosed and treated in accordance with standard medical practice by licensed medical personnel.
5. I hereby give permission to the Archdiocese of St. Louis & Assumption to use any photographs or video footage taken of my child in print and on their website for promotional purposes.
6. I understand that for all Youth Ministry activities there is a zero tolerance policy for the use of any mood altering chemicals (including alcohol and illegal drugs), foul language, disrespectful behavior, threats of any type of abuse and inappropriate physical contact. Any such behavior may result in expulsion from the event at the expense of the participant & guardians. Such behavior will also warrant probation from any future Youth Ministry activities at the discretion of the Youth Minister.
7. I understand that any luggage and belongings may be subjected to inspection by the Youth Minister or any other adult volunteers of the same sex prior to and throughout the trip.
8. I understand that all payments are non-refundable and that if payment is not made by the dates directed by the Youth Minister, my child’s spot will no longer be held.
9. I understand that this is a commitment my child and I are making. If my child for any reason needs to cancel his/her participation within one month of the activity, I am held responsible for the full cost and no refunds will be given.______________
Deposit: $100. Due by February 13th, 2022. Your spot will NOT be reserved for Steubenville until the deposit is turned in.
Please make all checks payable to Assumption Youth Ministry.
Scholarships are available! Requests must be made by March 1st!