Parish Youth Ministries Sr. High Weekend Registration Form November 6-8, 2015, Shrine Mont, Orkney Springs *For each Youth & Adult to fill out*
Please give this form to your youth leader/chaperone with the check. Youth must be accompanied by an adult.
Name: ______
E-Mail & Phone #: ______
Church name and location: ______
Date of birth & Gender: ______
Any special physical or dietary needs: ______
Name & email of chaperone: (REQUIRED) ______
Make check payable and mail to: The Diocese of Virginia Attn: Christian Formation Office c/o Mike Wade 110 West Franklin St. Richmond, VA, 23220-5095.
The weekend is $150 for ALL participants, both adult and youth. Scholarships are available as needed on a case-by-case basis, please inquire directly with the Christian Formation Office. Registration will be cut off on Wednesday the week of the event. If you are registering after this date, contact the Christian Formation Office directly.
Adult Advisors: Please send the cover letter with the list of the youth for whom you will be responsible at this event along with your registration.
Parents/Guardians: I understand that the Diocese will sometimes record images, sound or video of diocesan events for use in marketing and promotional material, and on Web sites owned by the Diocese. Last names are not printed in conjunction with photos of youth. If you do NOT want such images published of your child, please indicate by checking this box. [ ] Medical and Liability Release Form for Minors I hereby give my permission for my child to attend the Diocese of Virginia’s PYM weekend at Shrine Mont and in the event of an accident or illness, to receive emergency medical treatment as deemed necessary by a licensed physician. I also agree by execution of this document to release Parish Youth Ministries, the staff, the Diocese of Virginia, and all others acting for or on behalf of the Diocese of Virginia from all liability whatsoever, for personal injury, or damages to property, real or personal, caused by, or arising out of activities sponsored by Parish Youth Ministries. ______Signature (to be signed by parent/guardian of all conference participants) home______cell______work______Contact numbers for parent(s)
______Insurance company and policy number
______Emergency contact home______cell______work______
Please list any allergies or medical concerns below: Parish Youth Ministries Sr. High Weekend Chaperone Cover Sheet *FOR ADULT CHAPERONES ONLY (1 per group/church)*
Adult Chaperone: Please complete this form and attach all individual registration forms if possible when sending to Office of Christian Formation. Each youth participant must have their own registration form, with the medical release signed by the parent/guardian prior to arriving at Shrine Mont. Also, each adult must have their own registration form but do not need the medical release. The accompanying adult name(s) must be listed on this paper. You are responsible for having at least one adult per six youth.
NOTE: If you only have one adult you can still bring youth of the opposite gender in your group, just understand their room assignments might be a little further away from yours to be close to other youth and adults of the same gender. This assures that everyone is supervised appropriately.
Your name: ______Gender: ______
Your Church and location: ______
E-Mail: ______
Cell phone: (______) ______Home phone: (____) ______
Adult chaperones attending (and gender):
______
______
______
Names of youth attending (and gender):
______
______
______
______
______
______
______
______Details about the Weekend:
-Registration will start at 7:30 p.m., on Friday, Nov 6th, at Tucker Dining Hall (up the hill). -Dinner will NOT be available on Friday night so please plan accordingly and eat dinner before you arrive. -The first session begins at 8:30 pm in the Old Rec Hall above Tucker Dining Hall, and the weekend will conclude with our final session at 10:00 a.m. on Sunday morning. -To get to Tucker drive past the hotel (left) and up the hill bearing to your left at the fork. You’ll turn left again between two stone pillars and drive about 40 more yards directly towards the screened in gazebo. Tucker is the building connected to that gazebo, park in the gravel lot. -If you will be arriving late on Friday night, please call Shrine Mont with your estimated time of arrival and they’ll notify our staff. -We will be sleeping up and down the hill at Shrine Mont. Adult chaperones will be staying close to their youth, and rooming assignments will be given at registration. -PYM t-shirts are included in your registration fee and will be given out at the end of the weekend. -Shrine Mont’s phone number: (540) 856 - 2141.
What to bring……?
INDIVDUALS -Casual clothes – Remember: it can be cold! -Watch or alarm clock -Comfortable walking shoes -Rain Coat -Flashlight -Instruments! -Water bottle (very important!) -Crazy outfit for Saturday night, we’re going -Toiletries to have a dance!
GROUPS -Snacks -Games to teach -Activities for “Church time” on Saturday afternoon DO NOT BRING: Drugs, alcohol, cigarettes, any weapons, cell phones, iPods, MP3 Players, or any other internet ready devices. You will not need any money for the weekend. For Adult Leaders: Information and Expectations
This is a weekend of work for you. The PYM members will offer the program and activities, and will at times need your help to implement them. Your job is to make sure your youth attend sessions, meals, and are in their rooms and quiet after lights out. On Saturday afternoon, there will be some free time (we call it “church time”) for you to spend with your group. There will be a number or options for you and your youth but this is the time when the PYM committee gets a break and the youth are with their leaders. NOTE: The housing assignments are done in a way to try and put you and your youth close together in proximity but also to make sure we are adhering to the guidelines laid out to us by the “Safeguarding Gods Children” practices. In the unlikely scenario that you aren’t very close to your youth just know that another responsible adult chaperone is.
Also please understand that in some situations your youth might be rooming with another youth from another church. Often time’s youth (and adults for that matter!) can be apprehensive about sharing a room with someone they haven’t met before. We encourage your support in this area by not moving your youth out of his/her assigned room when at all possible. We find that at this age youth do not like rooming alone and the youth who do come alone are eager to meet/make new friends.
Tentative Weekend Schedule: (Subject to change)
FRIDAY 1:15 Church Time 3:00 Electives 7:30-8:30 Registration @ hotel front desk 4:30 Keynote speakers 8:30 Session 1 in Old Rec Hall & Rules 5:30 Dinner @ Tucker 9:10 Keynote speakers 6:15 Gather in Old Rec 9:40 Small Groups (adults to Chilton) 7:15 Dance in Old Rec 10:00 Evening activities 8:45 Talent show “late night” in Old Rec 10:40 Compline in Old Rec Hall 10:00 Go back to rooms 10:50 back to rooms 10:20 Lights Out! 11:20 in your rooms for sleep (Lights Out!) SUNDAY
SATURDAY 8:00 Breakfast @ Tucker 8:00 Breakfast @ Tucker 9:00 Gathering in Old Rec 9:20 Final Keynote session 8:30 Tour of Shrine Mont (leave from Tucker) 9:50 Final small group session – adult to Chilton 9:15 Keynote Speaker in Old Rec Hall 10:15 Closing Worship in Old Rec Hall/Shrine (weather) 1030 Workshops (adult free time) 11:15 BYE BYE!!! Thanks for coming!!! 12:30 Lunch @ Tucker Directions to Shrine Mont:
** use GPS/Google maps/MapQuest with caution, it might misguide you. We encourage you to use these directions because they are much easier to follow**
From Washington, DC: Shrine Mont is located 1 hour South of Winchester and approximately 2-1/2 hours from the Washington DC metro areas. To reach Shrine Mont, follow Route 66 West to I-81 South to Mt. Jackson (Exit #273). Turn left onto Rt. 703 (East), then right (South) on US 11, follow through town, turn right on Rt. #263 and follow approximately 15 miles to Orkney Springs.
From Richmond, VA: Shrine Mont is located 1 hour North of Harrisonburg, and approximately 3 hours from the Richmond metro areas. To reach Shrine Mont, follow I-81 to Mt. Jackson (Exit #273). Turn right onto Rt. 703 (East), then right (South) on US 11, follow through town, turn right on Rt. #263 and follow approximately 15 miles to Orkney Springs.
Questions? Contact Mike Wade (804 622 3190 or [email protected])