Register for 2024 Steubenville Main Campus 3

Parent/Guardian Information

Primary parent will receive all communication, unless otherwise stipulated.
Primary Parent/Guardian's Name*

First NameLast Name
Primary Parent/Guardian's Cell Phone Number*

Area CodePhone Number
Primary Parent/Guardian's E-mail*

Diocesan Permissions

Emergency contact should not be the same as the Primary Contact
I, {parentguardianName}, hereby give "My Child," {participantsName}, permission to travel (including in the airports, on the planes, and shuttles to and from the University) and participate in the Steubenville Main Campus 2 Conference trip to Steubenville, Ohio from July 10, 2025, until July 14, 2025.
Emergency Contact Name*
Emergency Contact Phone Number*
Emergency Contact Email*
Relation To Participant*
I certify that My Child is physically fit and capable of taking part in the Activity.

I give permission for my Child to receive any emergency medical treatment deemed necessary until the Emergency Contact(s) can be notified, and I agree I will assume full responsibility for the payment of such treatment.
I agree to the two statements above

Steubenville Conference Fee

Steubenville Deposit$50.00

Steubenville Full Payment$250.00

Parish Permissions
In the box below, I have listed any medical condition, physical disability, and medical, food, insect, and other allergy that may be relevant to rendering medical care. Any medication taken during the trip to and from the conference must be provided in its original container.
Allergies & Dietary Needs
I understand that photographs and videos of My Child may be taken, and I authorize their use for publicity.

I understand that staff will use their best efforts to supervise the Activity; however, I agree and acknowledge that the Roman Catholic Bishop of Manchester, a Corporation Sole d/b/a as the Sponsor Organization, and its respective directors, officers, trustees, employees, and volunteers shall not be responsible for bodily injury or loss of or damage to personal property that may result from the Steubenville Conference trip.

By signing below, I agree to all of the terms above.
Signature*

Clear
By clicking "Submit," I, as the parent/guardian, agree to pay the Full Payment of $250 by May 23rd (unless otherwise arranged with OLMM or Saint Theresa's) and agree to the cancellation policies stated above.
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Diocesan Permissions