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Appalachia Youth Registration 2025

Appalachia Youth Registration 2025

This application is for all youth who will be 16-17 years old by July 2025 (exceptions made for 15 year old's who are in the 10th grade).  Anyone who will be 18 or older by July 2025 must fill out the Adult Form.  Only youth registered with St, Patrick, St. Vincent or Pius X youth ministries may register before March 1, 2025.
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    MEDIA RELEASE AND CONSENT

    I hereby give Certain Place Ministries, Inc. (“CPM”) together with the "Work Week Group”, and their licensees, including organizers and sponsors of events in which the Work Week Group participate, the right to photograph, film, record, or capture, my name, image, voice, statements, and likeness (collectively "Likeness") and the Likeness of members of my family (including my children), whose names are listed below (collectively “Family Members”).  I further consent to the use, reuse, reproduction, license, display, and publication of such Likeness without restriction, in any and all media now known or hereafter devised throughout the universe in perpetuity for any purpose whatsoever in connection with the promotion of CPM, the Church and Appalachia work weeks and their licensees, including without limitation any commercial or noncommercial use on websites, social media, news or advertising. I understand that my Likeness and the Likeness of my Family Members may be combined with other images, videos, text, and/or graphics and may be cropped, altered, or modified. I hereby hold the Work Week Group and their licensees harmless and forever waive and release any claims against the Work Week Group and their licensees based on any rights of privacy, publicity, defamation, copyright infringement or any other right that may arise from or be related to the use, exhibition, license, modification, distribution, publication, or reproduction of my Likeness or the Likeness of my Family Members. I understand that no compensation will be provided to me or my Family Members for or in connection with any use of our Likeness. I represent and warrant that I am at least 18 years of age and able to provide this consent.

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    Activity/Event: The Appalachia Help Week (the “Activity”)

    Date of Activity/Event:  July 6- August 2, 2025

    Location of Activity/Event: VFW, Rowlesburg, WV and the surrounding county

    Transportation:  I understand and acknowledge that transportation (including air travel) arrangements to and from Rowlesburg, WV and throughout Preston County during the week of service are the volunteers' responsibility whether my teen travels in my own personal vehicle or with another individual(s). I additionally understand and acknowledge that in the event that my teen travels in my own personal vehicle, I agree that I am responsible for my own acts and for the safety and security of my own vehicle.  I accept full responsibility for the liability of myself and my passengers, and I understand that if my teen is a passenger in a private vehicle, Certain Place Ministries, Inc. is not in any way responsible for the safety of such transportation.  I further agree that Certain Place Ministries' insurance does not cover any damage or injury suffered in the course of traveling in a private vehicle.

    Assumption of Risks: I understand that participation in this Activity carries with it certain risks and hazards directly or inherently involved that cannot be eliminated regardless of the care taken to avoid injuries: The risks include but are not limited to: 1) minor injuries such as scratches, bruises, and sprains; and 2) major injuries such as joint or back injuries, broken bones, head injuries, severe physical trauma, heart attack and stroke; or 3) other potential risks of loss of limb, property or life.  I also understand and recognize that there are risks and hazards directly or inherently involved in travel to and from this Activity and while participating in this Activity, and I expressly assume those risks.  With full knowledge of the facts and circumstances surrounding this Activity, I voluntarily allow my teen to undertake this Activity and assume all responsibility and risk associated with his/her participation in this Activity, including all risk of injury, property damage, injury to others, and other hazards to him/her. 

    Waiver: In consideration of my teen's voluntary participation in this Activity/Event and whether or not he/she travels to and from this Activity in my own personal vehicle, or whether he/she travels with another individual(s), I for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and agree to hold harmless CERTAIN PLACE MINISTRIES, INC.; its trustees, officers, agents, employees, volunteers and those for whom CERTAIN PLACE MINISTRIES may be held responsible, from any and all claims of liability for personal injury, accident, illness or death, and property loss arising from my participation in this Activity.  I allow my teen to willingly participate in this Activity and I assume any and all associated risks.

    Assurances:  I assure officials of Certain Place Ministries, Inc. that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my teens's participation in this Activity.   I further assure that there are no health-related reasons which preclude or restrict my teen's participation.

    Code of Conduct: I acknowledge that during the course of this trip, my teen is bound by the rules contained in the Appalachia Help Weeks list of rules and by the Diocese of Wheeling-Charleston compliance form. 

    INDEMNIFICATION:  I AGREE TO INDEMNIFY AND HOLD HARMLESS CERTAIN PLACE MINISTRIES, INC., ITS  TRUSTEES, OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, VOLUNTEERS AND THOSE FOR WHOM THE CERTAIN PLACE MINISTRIES MAY BE HELD RESPONSIBLE FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, PROCEDURES, COSTS, EXPENSES, DAMAGES AND LIABILITIES, INCLUDING ATTORNEY’S FEES BROUGHT AS A RESULT OF MY TEEN'S INVOLVEMENT AND PARTICIPATION IN THIS ACTIVITY  INCLUDING BUT NOT LIMITED TO, ANY DAMAGE TO MY PROPERTY OR THE PROPERTY OF OTHERS AND INJURY TO MY TEEN OR TO OTHERS, INCLUDING LOSS OF LIMB OR LIFE, ARISING OUT OF PARTICIPATION IN THIS ACTIVITY.

    Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the laws of the states of New Jersey, West Virginia and Arizona and that if any portion of it is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

    Acknowledgement of Understanding:  I have read this waiver of liability, assumption of risk, release and indemnity agreement, fully understand its terms, and understand that I am assuming all risks associated with this Activity/Event and giving up substantial rights.  I recognize that this Release means that I am giving up the right to sue CERTAIN PLACE MINISTRIES, INC., its trustees, officers, agents, employees, volunteers, and those for whom CERTAIN PLACE MINISTRIES may be held responsible, for injuries or losses my teen may incur, and I understand this Release binds my heirs, executors, administrators and assigns, as well as me.  I acknowledge that I, and as a minor, my teen, are signing this document freely and voluntarily and intend by our signatures to completely and unconditionally release the above-named parties of all liability to the greatest extent allowed by law.

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    I agree to the above Release (Please sign your name. If unintelligible, we may ask you to do it again)
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    I agree to the above Release (Please sign your name. If unintelligible, we may ask you to do it again)
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    Registration Fee

    $300 for St. Patrick, St. Vincent, St. Gerard, St. Rose & Brophy volunteers with an expectation and goal that the total amount raised by each parish/school be the equilent to or more than $500 per volunteer before July 2025. 

    Pius X volunteers fee is $800 ($300 deposit is required with registration)

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