Sawyerville Person2Person Youth Application

Person2Person Youth Participant
One of Sawyerville's three goals is to improve race relations in Alabama. In all of our programming, we teach our campers, students, participants, and staff to love one another with no exceptions, as Jesus loves us, and to respect the dignity of every human being, as our Baptismal Covenant requires. Our actions are not produced from pity or division, but rather respect, relationship, and seeking Christ in each other.

At Person2Person, participants and staff learn about the history of race in Alabama, current events involving race, and what individuals can do to create positive change. High school students who have staffed Sawyerville Summer Camp or who will staff during Summer 2024 are invited to apply to attend Person2Person. This event is at not cost to participants and staff.

When: Friday, January 12 - Monday, January 15, 2024

Where: St. Paul's Episcopal Church, Selma, Al; St. John's Episcopal Church, Montgomery, Al

Questions? Contact Bre Mitchell, breanna@sawyerville.org

Learn More: https://www.sawyerville.org/person2person.html
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Gender*

MaleFemaleGender Not ListedRather Not Say
T-Shirt Size*

Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargeAdult XXX-Large
Dietary Restrictions and/or Allergies*

Gluten-FreeVegetarianVeganNo dietary restrictions/allergiesOther
List food allergies*
Type "N/A" if there are no dietary restrictions/allergies
Short Answer Questions
What do you hope to learn from Person2Person?*
Tell us a brief story about an experience that helped shape your understanding of race. *
Share one way you have committed to respond to racial injustice. What is one way you are working against racism, "big" or "small"?*
Medical Information
Medication(s) at Event*
Name of Insurer*
Name on Insurance Card*
Policy Number*
Group Number*
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Youth Release

A parent/guardian must be present when filling out this portion of the application. Please have them sign the consent forms below. Your application is not valid otherwise.
Covenant of Common Life

I agree to live by the standards set for the event. I understand there is no use or possession of alcohol, tobacco products, illegal drugs, or weapons of any kind. I understand inappropriate sexual behavior is not tolerated. In order to respect all participants' privacy, at no time may a male enter a female housing site or a female enter a male housing site. If I choose to violate these standards or jeopardize the work of this ministry or am knowingly in the presence of others violating these standards, I will be sent home immediately at my own expense. In an effort to foster an inclusive atmosphere, common areas for males and females to gather will be defined.
Covenant of Common Life Signature (signed by youth participant)*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Agreement:

I give permission for my minor child to attend and participate in the events and activities of Sawyerville Person2Person sponsored by the Episcopal Diocese of Alabama. I do hereby, for myself and for my child, release the Episcopal Diocese of Alabama, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my child while participating in or traveling to and from the Sawyerville Person2Person activities. I give permission to Sawyerville, without limitation or obligation to use photographs, film footage, or tape recordings which may include camper’s image or voice for purposes of promoting or interpreting its programs and release Sawyerville from any claim of liability for that use. I give permission to Sawyerville, without limitation or obligation to use photographs, film footage, or tape recordings which may include camper’s image or voice for purposes of promoting or interpreting its programs and release Sawyerville from any claim of liability for that use.
Parent/Guardian Agreement Signature (signed by parent/guardian)*

Clear
Date*

MonthDayYear
Date
Parental/Guardian Medical Consent

I hereby authorize all the adult volunteers & medical staff of the event, to seek and consent to any medical, surgical or dental treatment for my child as needed, to be rendered under the general or special supervision and on the advice of any licensed physician or dentist; and I further agree to be liable for and to pay all costs and expenses incurred in connection with such medical, surgical or dental services rendered to my child pursuant to this authorization.
Parent/Guardian Medical Consent Signature (signed by parent/guardian)*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Person2Person Youth Participant

Short Answer Questions

Medical Information

Parent/Guardian Information

Youth Release