Registration Form - Saint Joseph Catholic Church • Jasper, Indiana

All Middle School Participants and High School RYF Team & Adult Chaperones… Complete and sign all forms with $40 registration fee (check payable to
“St. Joseph Church”). Jasper youth: Drop off at St. Joseph Parish Center or Mail to: St. Joseph Church, ROCK YOUR FAITH, 1029 Kundek Street, Jasper, IN
47546 by June 12th. All other youth: Send your paperwork through your parish Youth Minister or PCL and provide a chaperone over the age of 21 for
every 8 youth. Chaperones for the Jasper Parishes are provided. Youth Ministers and PCLs… please send a list the names of students and their
chaperone(s) with your registrations. Please turn in Registration forms and fees by June 12th – Thank you! (Fee Scholarships are available.)
ROCK YOUR FAITH Registration & Waiver
_____Middle School Participant Circle Grade 2015/16:
6th, 7th, 8th
_____ High School RYF Team Circle Grade 2015/16: 9th, 10th, 11th, 12th
T-shirt size (circle one) YM YL - Adult S M L XL 2X
T-shirt size (circle one) YL - Adult S M L XL 2X
Name _______________________________________________________
Name _________________________________________________________________
Home Parish _________________________________________________
Home Parish ____________________________________________________________
Parent Email address____________________________________________
Email address__________________________ Parent email___________________________
Address _____________________________________________________
Address ____________________________________________________________
City, State, Zip __________________Phone (____) __________________
City, State, Zip __________________Phone (____) _________________________
Cell (_____) ____________________ Birth Date _____/_____/_____
Cell (_____) ___________________ Birth Date _____/_____/_____
Sex: _____ AGE _____ HS Grad. Year ______
Sex: _____ AGE _____ HS Grad. Year ____
NOTE: ANY PARTICIPANT UNDER 18 YEARS OF AGE MUST HAVE A WRITTEN PERMISSION
SIGNED BY A PARENT OR LEGAL GUARDIAN TO LEAVE THE EVENT DURING RETREAT HOURS.
NOTE: ANY PARTICIPANT UNDER 18 YEARS OF AGE MUST HAVE A WRITTEN PERMISSION
SIGNED BY A PARENT OR LEGAL GUARDIAN TO LEAVE THE EVENT DURING RETREAT HOURS.
All High School Youth must also receive approval of the Rock Your Faith Leadership
Committee prior to being able to participate. Your role will be one of leadership, service,
and mentoring middle school youth.
_____ My child will not be spending the night on Tuesday, June 30th.
_____ My child will not be spending the night on Monday, June 29 or Tuesday June 30th.
_____ My child will be spending the night at St. Joseph on Tuesday, June 30th.
If spending the night, need: toiletries, change of clothes, air mattress/sleeping bag/pillow
_____ My high school child will be spending the night : Monday_____ Tuesday ______
If spending the night, need: toiletries, change of clothes, air mattress/sleeping bag/pillow
For More information contact:
Carley Knapp at (812) 481-2442, cknapp@evdio.org
Pam Freyberger (812)482-1805 ext 211, pfreyberger@evdio.org
ALL CHAPERONES & ADULT (OVER 17) VOLUNTEERS MUST COMPLETE THIS SECTION,
YOUTH PROTECTION TRAINING AND BACKGROUND CHECK
I have completed Youth Protection Training in ___________________________Parish
(city) ___________________. I am 18 years old or older and have completed a Diocesan
Criminal background check _____ Yes
YPC Signature____________________________