June 12-15, 2016 - St. Elizabeth Ann Seton

SETON and All SAINTS YOUTH MINISTRIES present...
“Mission Possible service Week”
June 12-15, 2016
Open to 6th thru 12th graders (2016/2017) and Seniors 2016!!!
Participants of “Mission Possible service Week“ 2016, are invited to SHARE THEIR GIFTS with those in need!!!
with participants from all around the Dallas Diocese…to share your DIFFERENT GIFTS!!! 2016 marks the 22nd year for this event!
Each summer our Seton and All Saints Parish Communities have been blessed to collaborate on this event, as the “Plano 1 Region”
and have over 200 participants who are willing to brave the heat…get off the couch…and SERVE!!!
Sunday, June 12th our week will begin in the St. Elizabeth Ann Seton Gym, in the Faith Formation Center, “host parish” (3100 W Spring
Creek Pkwy) to get to know each other, participate in service and service learning activities, have FUN and celebrate Mass together!
Families are encouraged to join us for MASS in the Seton sanctuary June 12 th at 5:00pm (2700 W Spring Creek Pkwy Plano, Texas 75023)
Monday thru Wednesday, June 13th ~15th —participants gather in the Seton Gym: Adults (3100 W Spring Creek Pkwy)
They will gather in work crews, based upon prescribed Adult to Youth ratios and transportation. Our days will include: team building
activities, “service learning” activities based on our Catholic Social Teachings, large group activities, fun and prayer. Crews will travel
to different service sites each day, in an effort to expose participants to a variety of service opportunities.
Each participant brings their own lunch and the crews take time at their service site to eat, have faith discussions and pray.
Youth participants pay $50.00 (check made to Seton or All Saints—the parish with which you are affiliated).
The Youth fee goes toward: snacks, supplies for the week, MP t-shirt, “cleared Adult” registrations and
our MP “wrap up” activity at on Wednesday evening—TBA
Additional Donations are graciously accepted and will be used for scholarships and supplies!
As our SOLIDARITY PROJECT we will collect the “TWELVE MOST WANTED FOOD ITEMS” to donate to area food pantries
(see list on www.setonparish.org\YM webpage) BRING items by Tuesday of our week—so we can deliver on Wednesday!
Schedule for Mission Possible WEEK - (Gather in Seton Gym, 3100 W. Spring Creek Pkwy Plano):
SUNDAY, June 12th in Seton Gym (eat Lunch before you arrive),
- Cleared Adult Leaders arrive at 12:30pm
- Youth MP Participants arrive at 1:00pm. Then, Parent pick up 6pm at Seton CHURCH, after 5pm Mass
MONDAY & TUESDAY, June 13-14th:
- Youth MP Participants arrive at 7:30am
- Cleared Adult Leaders arrive at 7:15am, for babysitting check in is at 7:00am (you may bring your “participant child “ when you come)
4:00pm YOUTH PICK UP—from Seton Faith Formation Center SOUTH parking lot (playground entrance)
WEDNESDAY, June 15th: same arrival schedule as Monday and Tuesday
BUT!!! - Wednesday includes our “wrap-up” activity TBA.
Since space availability for participants is based on the number of “Cleared” Adults committed to the week,
registrants will be notified by the Youth Ministry office if they are put on the “Participant List” or have been placed on a “Wait List”
This week is only possible with the help of caring Adult Leaders!!!
Space availability for Youth participation is based on the number of “Cleared” Adult Leaders who are willing to commit to the week
Baby Sitting for your younger children is provided (and we need some babysitters, if that is your gift!)
If you are interested in volunteering as an Adult Leader OR you have questions...
Please contact your Parish YM Office:
Seton—Jeri Phillips jphillips@eseton.org
ALL SAINTS—Paul Bianchi PBianchi@AllSaintsDallas.org
LEADER TRAINING—June 7th, Thursday–7:00 p.m. for NEW leaders and 8:00pm for Veteran Leaders
(in Seton Youth Room)
JUST SO YOU KNOW...Here’s what ALL Participants of MP must agree to!
CODE OF CONDUCT for “Mission Possible” Service Week participants:
1. I agree to treat other participants, leaders, staff, clients and residents with respect and understand that all adult leaders have the authority to discipline me.
2. I will always follow the schedule and guidelines given to me.
3. I understand that alcohol, weapons (including ALL knives), fireworks, tobacco products of any kind, illegal drugs
and profane or abusive language are NOT ALLOWED on any part of this activity. (Prescription drugs for minors
must be dispensed by adult leader except inhaler.)
4. I understand that I represent SETON and ALL SAINTS YOUTH MINISTRIES and agree to behave in a Christian
and positive manner at all times. I further agree to dress appropriately during this activity. (Shorts should be at least
fingertip length).
5. Sexual indiscretion (includes inappropriate touching) is prohibited at all times and in all cases.
6. No participant is allowed to leave before activity conclusion, without written parent permission
7. In the event of an emergency or other need to contact any participants, the staff must know where I can be located,
therefore I agree to stay with my assigned group at all times.
8. I agree to arrive no earlier than 10 minutes prior to scheduled start time of event and be picked up no later than 10
minutes after scheduled event conclusion. By attending this function all participants agree to stay until the function’s conclusion, unless they have a medical emergency. I realize that I, and my parents, will be financially responsible for any damage I do to others’ property, facilities or vehicles.
9. I understand that if I choose to violate any part of this “code of conduct”, I run the risk of having my parents notified by phone, or in person, and asked to pick me up, immediately. (This determination will be left to the discretion of the event coordinator.)
10. I understand MP is a “service” activity. I WILL be called to WORK as part of a crew!
11. MP NAMETAGS must be worn and visible AT ALL TIMES. This holds your name tag and medical release form.
“Basic” required duties of an Adult Leader:
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Be willing to facilitate a small work crew; by overseeing the crew during service learning, work site, team building
and large group activities. (Facilitation training and instruction will be provided)
Must be 21 years or older and have completed “Safe Environment” process and training in their home parish.
Complete “Volunteer Driver” form and provide copy of current driver’s license and vehicle insurance card to Parish
Youth Ministry coordinator
Have a vehicle in good working conditions with properly functioning seatbelts, brakes, tires and wiper blades.
Agree to participate in all Mission Possible Service week activities, unless other arrangements have been made with
Parish MP Coordinator.
Attend MP Adult Leader training on June 7th and be familiar with Adult Leader Handbook, which you will
receive at Mission Possible Adult Leader Training.
Transport youth in your crew to and from worksites...and TO the Thursday night closing activity at Hawaiian Falls.
Pray for all participants of Mission Possible…especially their work crew!!
Additional “Code of Conduct” items for Adult Leaders:
 I understand my primary function during Mission Possible is to ensure the safety and wellbeing of all youth participants in a safe and faith-filled environment – especially, but not limited to, those in your group.
 I will know the whereabouts of all youth in my charge at all times…including breaks.
 I will be assertive, while compassionate, in guiding the young people with whom I work.
Both YOUTH and ADULT MP Registration form can be found on the Seton Youth Ministry website
Since space availability for participants is based on the number of “Cleared” Adults committed to the week,
registrants will be notified, by the Youth Ministry office, if they are on the “participant list” or have been put on the “wait list”
Participants will be emailed additional specific information once they have registered for the event.
VISIT YOUR Parish website for more info:
Seton YM www.setonparish.org\YM or All Saints YM www.asymdallas.org
MISSION POSSIBLE SERVICE WEEK
June 12~15, 2016
Cost: $50 (make checks payable to YOUR Parish) - Deadline May 16, 2016
More info on your parish YM website: www.setonparish.org\YM
or
www.asymdallas.org
Please return form & payment to Seton YM Office — questions call 972-398-5400 X 4285 Jeri Phillips
YOUTH
REGISTRATION
After your Registration form is received, you will be contacted—via e-mail—as to whether you are on the
“Participant List” or the “Wait List” (we are limited as to the number of Youth participants, based on the
number of “cleared adult” we have commit to the week.)
Seton—jphillips@eseton.org or All Saints—PBianchi@AllSaintsDallas.org
PLEASE PRINT—YOUTH INFO: We would like make an additional donation for scholarships and supplies...of $ _______
Please wear your YELLOW MP shirt! But if you need a new one Circle size:
Youth Lg Sm Med Lg
XLg
2XLg
3XLg
4XLg
Last name________________________ First name_____________________ D.O.B___/___/__ Gender: M or F
Hm. Address__________________________________ City_________________
Youth E-Mail______________________________________________
Church ________________________________
State____
Zip______________
Youth Cell Phone_____________________
Grade NEXT YEAR 2016-2017 __________
One friend I would like to be grouped with - __________________________________ (no guarantees, but we’ll try)
For office use
ck.# ________
date________
Amt ________
cue #_______
PARENT, GUARDIAN or CONSERVATOR—INITIAL any that apply — **DO NOT INITIAL ALL AREAS AS ONE MAY CANCEL OUT ANOTHER**
______ This child takes no medication and will bring no medication with him/her.
______ This child takes medication/s and will self-medicate. The child will bring all such medications necessary, and such medications will be clearly labeled. I understand that the child will be required to turn all medication(s) over to a supervising adult designated to keep medication(s). I further understand
that it will be this child’s responsibility to present himself/herself at a location designated for returning medication(s) to this child at the frequencies/times
listed below. I understand that the adult to whom this child surrenders the medication has no medical training and this adult will not measure dosages. This
child will return the medication(s) to the adult after he/she self-medicates. At the conclusion of the event it will be this child’s responsibility to pick up remaining medication(s), if any, at the self-medication designated location. Names of medications and exact dosage and frequencies/times are as listed below:
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
NOTE: Should your child have an Emergency Injection Device (Epi-Pen), Diabetic Condition, Asthmatics with a rescue inhaler, or other special medical condition, it is important to provide a clear description as to the nature of the medical condition and any medication. This is important for situations where the youth becomes unable to selfadminister these treatments and to communicate with Emergency Response Personnel. If a child, who is normally able to self-administer these medications becomes unable to
self-administer or is in distress, youth ministers, volunteers, or other parish personnel will immediately call 911 to summon Emergency Medical Personnel to respond to the
medical emergency. Youth ministers, volunteers, and other parish personnel are NOT trained to administer these types of emergency medications.
____This child takes medication but is unable to self-medicate. Child’s parent/guardian/conservator will provide all medications, for an adult to dispense.
____ I grant permission for the following nonprescription medication to be given to this child:
Non-aspirin/pain reliever Yes ________ No ________ # of tablets per dosage________
Throat Lozenge Yes ________ No ________
Decongestant Yes ________ No ________ # of tablets per dosage________
Antacid Yes ________ No ________
Antihistamine Yes ________ No ________ # of tablets per dosage________
Other _____________________________
Dosage __________________________________________________
Specific Medical Information:
Allergic reactions (medications, foods, plants, insects, etc.) _____________________________________________________
Immunizations: (date of last tetanus/diphtheria immunization) _______________________________
Other Medications child currently takes: _________________________________________
Any physical limitations: ______________________________________________________
Has child recently been exposed to contagious disease or condition such as mumps, measles, chicken pox, etc.? Y N
If so, date and disease or condition. _______________________________________________________________________
Any other special medical conditions of this youth that we should be aware of?
___ No medication of any type, prescription or nonprescription, may be given to this child, unless emergency treatment is required in life-threatening case.
PLEASE COMPLETE BOTH SIDES OF FORM
PLEASE PRINT
YOUTH MP participant Last Name_____________________________, First Name_____________________
TO BE FILLED OUT BY PARENT, GUARDIAN, CONSERVATOR
CONSENT TO PARTICIPATE AND LIABILITY RELEASE
I, _________________________________________ the parent/guardian/conservator of ________________________ (child name)
grant permission for my son/daughter to participate in all youth activities and functions.
I understand that as parent/guardian/conservator, I remain legally responsible for any personal actions taken by my son/daughter. I recognize the
inherent risk associated with the various youth activities that my son/daughter will be participating in. I agree on behalf of myself, my son/
daughter named herein, my heirs, successors, and assigns to indemnify, defend, and hold harmless St. Elizabeth Ann Seton Parish, All Saints
Parish and the Roman Catholic Diocese of Dallas, their employees and/or volunteers from any and all claims (unless due to the Sole or Gross
NEGLIGENCE of the Parish) for illness, injury, death, and the cost of medical treatment therewith, arising from or in any way connected with my
son/daughter participating and/or attending the various youth programs and activities during this formation year noted above.
In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed
that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, reasonable attorneys’ fees and expenses incurred by the prevailing party.
AUDIO/VISUAL RECORDING AND PHOTOGRAPHY CONSENT
On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan
sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. As the State of Texas
does not prevent audio or video recording or the photographing of children/youth (with the exception of Senate Bill 1, Section 26.009, which deals
specifically with school districts), it does encourage parental consent. Additionally, current video recordings and photographs assist law enforcement agencies dealing with the Missing Children’s Program.
I consent to the use of such materials in which my child may appear. I release the staff and volunteers of St. Elizabeth Ann Seton Parish and the
Roman Catholic Diocese of Dallas from any liability connected with the use of my child’s picture or audio/video recording as part of any of the
above or similar activities.
AUTHORIZATION OF CONSENT TO TREAT MINOR
I, ____________________________________ am the (initial one) ___ parent ___ guardian or ___ conservator of
_____________________________ (child name), a minor, and as such do hereby authorize St. Elizabeth Ann Seton Parish and All Saints Parish, its youth ministry leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general
or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given,
whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. It is understood that this
authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment, or hospital care
which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of
Chapter 32 of the Texas Family Code. This authorization shall remain effective throughout the specific event dates listed above. In consideration
of acceptance of this authorization, but without any time limitation and without any future right of revocation, I hereby release, defend and hold
harmless the Parish and Roman Catholic Diocese of Dallas (Diocese), their officers, directors, agents, employees, volunteers, youth ministry leaders, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment
decisions.
Insurance Carrier: ___________________________________________________________________________________
Policy Number: ___________________________________
Insurance ID Number: _____________________________
**PLEASE ATTACH A PHOTOCOPY, front and back, OF Child’s HEALTH INSURANCE CARD**
My child and I have read and agree to the “Code of Conduct” (available on the Mission Possible Informational page)
_________________________________________________________
Signature of Parent/Guardian/Conservator
_______________________________
Date Signed
PRINTED Name of—Parent, Guardian, Conservator __________________________________
Home Phone Number_____________________________
Mobile Phone Number____________________________
Address (if different than the child’s) ______________________________________________
Parent, Guardian, Conservator E-Mail_______________________________________________________
__________________________________________________________ _______________________________
PRINTED—Name & Relationship of Secondary Emergency Contact
Mobile Phone Number
PLEASE COMPLETE BOTH SIDES OF FORM
Peanut Butter
Granola Bars
Cereal
Pop Top items
Canned Tuna
Canned Soup
Capri Sun
Chili
Canned Meats
Beans
Oatmeal
Pop Tarts
Adults...Seton Youth Ministry
needs your Help
to make our
“Mission Possible”
Adult Leaders are needed to help facilitate
“Mission Possible” Service Week June 12~15, 2016.
Mission Possible is an Inter-Parish, in-town service week for
Middle School, High School Youth and “Cleared” Adult Leaders which
began in 1995! This event is supported by the Diocese of Dallas and
usually has participation from over 1,200 participants, from 28 parishes.
Seton is the “Plano 1 region” host...with cooperative leadership from All Saints too!
Youth Participation in Mission Possible is limited to a ratio of 5 Youth per 1 “Cleared” Adult
Leader. Therefore, it is VERY important for us to begin the process of lining up our Adult
leadership for this amazing event NOW! Please consider sharing your time with youth!
Adult Leader TRAINING is provided and…babysitting (“mini-possible”) will be available for
younger children of Adults who commit to the week!
Prior to the event, Adult Leaders need to...
- Be 21years old or older and complete the Seton “Safe Environment” Process, by the event date
- Attend Mission Possible training session on JUNE 7th
During “Mission Possible service Week” aDult leaDers...
- Help facilitate small group (workcrew) activities and discussions,:
Sunday 1:00-6pm (includes 5pm Mass) and Mon. thru Wed. 7:15am~4:00pm
- Provide transportation for their crew to and from service sites
- Connect with service site coordinator and other crews at the service site
- Help oversee your work Crew during activities while at service site
- Help transport youth for our closing FUN on Wednesday—TBA
YOU CAN HELP MAKE OUR MISSION POSSIBLE!!!
For more information or to volunteer—please contact
Your PARISH YM office
Seton: jphillips@eseton.org or All Saints: PBianchi@AllSaintsDallas.org
MISSION POSSIBLE SERVICE WEEK
June 12~15, 2016
There is NO CHARGE for “cleareD aDults”
who volunteer for MISSION POSSIBLE
Babysitting is available, by reservation,
for younger children of Adult MP Volunteers.
FOR INFO contact your parish YM office: Seton—jphillips@eseton.org or All Saints—PBianchi@AllSaintsDallas.org
Please Register by May 5th...so that we may better judge how many YOUTH we will be able to place
on the “Participant List.”
Remember, Mission Possible is a 4 DAY EVENT this year!
MP Adult Leader Training—in the Seton Youth Room June 7th—7:00 New MP leaders, 8:00pm veteran MP leaders
ADULT REGISTRATION—
Please Print
Please wear your YELLOW MP shirt! But if you need a new one Circle size:
Sm Med Lg
XLg
2XLg
3XLg
4XLg
Last Name_____________________________ First Name___________________ D.O.B.______/______/______ Gender: M or F
Address_____________________________________________ Hm Phone#__________________ Cell #_______________________
City___________________________________ St_________ Zip____________ Church____________________________________
Email________________________________________ NUMBER #____ of seatbelts in my vehicle INCLUDING the driver!
CHECK ONE: ____ I would like my MS or HS aged child in my crew - my Child’s: Name ___________________ Grd_____
____ I would not - like my child in my crew
CONSENT/RELEASE FORM
I hereby agree to participate in “Mission Possible Service Week June 12~15, 2016 with St. Elizabeth Ann Seton Youth Ministry of
Plano, Tx. and All Saints Church of Dallas, Tx. I understand all reasonable precautions will be taken to keep adult and youth participants
safe during this event. I will not hold St. Elizabeth Ann Seton Church, All Saints Church, the Diocese of Dallas, members of their staff
or their volunteers, responsible for accidental harm or injury that may occur during this activity. In case of an emergency during this time, I
hereby consent to and authorize the giving of treatment and or medication ordered by a physician or adult for my care.
On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of participants of church and diocesan sponsored
activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. I consent to the use of such materials in
which I may appear. I release the staff and volunteers of the above named entities from any liability connected with the use of my picture or audio/
video recording as part of any of the above or similar activities.
I have read and agree to the “Code of Conduct” (available on the Mission Possible Informational page)
Adult Participant Signature_____________________________________
Date__________________
Ins. Co. Name & Phone__________________________________________________________________ Policy#____________________
Current Medications: _____________________________________________________________________
Allergies_________________________________________________________________________________
Emergency Contact Name and Number_______________________________________________________
Special health considerations:____________________________________________________________________________________
I DO need babysitting:
Name and age(s) of child(ren) __________________________________ Age_____
___________________________________________ Age_____
___________________________________________ Age_____