As a Young Person at DCYC, I Will

Welcome to Diocesan Youth Ministry. The event you are attending may have several purposes but the most important is to bring Catholic youth together from across our Diocese to play, pray, learn and grow and get excited about being Catholic and an important part of our Church. Remember you are representatives of a respected Catholic youth organization. We expect you will represent your parish and diocese well during this event. Recall that you are a witness for your church to the press and dignitaries who will attend the event and we ask you to project an image of Christian consideration, sensitivity, and respect to everyone and to the property around you. We are confident you will display the maturity, responsible leadership and character, which have become the trademark qualities of Catholic youth ministry. Thank you!

Parish group leaders are responsible for the actions of the members of their group. Each parish accepts full responsibility for any damage or theft caused by members of their group while attending DCYC 2015. Adult chaperones in each parish group are to help enforce the Code of Conduct and to set an example for their youth. All diocesan adult leaders and chaperones have been background checked, cleared and trained in compliance with the safe environment policies of the Diocese of Dallas. As such they have been given the authority to maintain safety and adherence to this Code of Conduct. Please give them your respect and cooperation.

As a young person at DCYC, I will:

1. Respect each person whether youth, adult, child, in our group or not a part of our group. This is the cornerstone of our faith and a civil society. Respect includes verbal exchanges, physical and psychological exchanges as well. Inappropriate displays of affection as well as any abuse of another person will not be tolerated.
2. Honor the equality of all people, avoiding all forms of discrimination and respecting the dignity of each person without regard to economic status, age, gender, race, ethnicity, religion, sexual orientation, or physical or mental abilities.
3. Use positive reinforcement and communication rather than criticism, unhealthy competition, or comparison.
4. Know that the purchase, possession, or consumption of beer, wine, other alcoholic beverages and the possession or use of illegal drugs by any individual will not be tolerated. The use of tobacco products by minors is prohibited. The purchase, possession, download or distribution of pornography is always inappropriate and inexcusable at any Catholic youth ministry event. Failure to comply with these rules can warrant immediate dismissal from the event.
5. Conduct myself in a manner that exhibits the highest Christian standards and respect to everyone and the property around me through my language, dress and behavior.
6. Be responsible and/or accountable for good stewardship of all resources.
7. Remember that vandalism to property is never allowed at any event. Such behavior can result in serious injury to persons and/or property. Offenders may be asked to leave the event and will be responsible for reimbursing the owner for damages.

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As a young person at DCYC 2015, I will:

1. Be on time! Event sessions will start on time. Please arrive promptly and stay for the entire event.
2. Attend all DCYC event activities. Name badges must be worn at all times during the event.
3. Be aware of and adhere to emergency plans and instructions for DCYC 2015.
4. Uphold the authority of those responsible for the program or activity in which I am participating and assist them in every way to encourage learning and fairness.
5. Adhere to all event rules and curfews.
6. Be aware that due to schedule and safety concerns, the hotel pool area is off-limits for all DCYC participants.
7. Be aware of noise levels in lobbies, hallways and sleeping areas, especially later in the evenings.
8. Maintain the spirit of the event.
9. Report problems of any kind to a trusted adult

As a young person at DCYC, I will not:

1. Possess a weapon of any kind.
2. Possess, purchase, consume or distribute alcohol or illegal drugs.
3. Purchase, download, possess or distribute pornography of any kind.
4. Engage in any form of sexual activity or peer sexual harassment
5. Participate in any form of bullying.
6. Visit or gather in hotel rooms other than my own.
7. Leave the hotel or conference center without being accompanied by an adult and without the knowledge and approval of my group leader.

St. Patrick Parish, DallasDCYC 2015 Youth Permission and Travel Form

Youth’s Name ______

Home Address ______

City ______State ______Zip ______

Primary Phone ______Secondary Phone (optional) ______

The email addresses listed below may be used for communication with myself and/or my son/daughter regarding this event.

Primary E-mail Address (please write legibly) ______

Secondary E-mail Address (optional) ______

Date of Birth ______Gender (Circle one) M or F Grade in School (2015/2016) ______

T-Shirt Size (circle one) (adult sizes) S M L XL 2XL 3XL

PERMISSION TO TRAVEL

I, ______grant permission for my child, ______to participate in the below described parish event and youth activities. A brief description of the activity follows:

Description of event: __Dallas Catholic Youth Conference ______

Date of event:__July 31 – August 2, 2015______

Destination of event: __Embassy Suites Hotel / Frisco Convention Center______

Estimated time of departure and return: __TBD______

Mode of transportation to and from event: __Personal Vehicles______

CONSENT TO PARTICIPATE AND LIABILITY RELEASE

I, ______the parent/guardian/conservator of ______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. Patrick 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 the dates 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.

AUTHORIZATION OF CONSENT TO TREAT MINOR

I, ______am the ___ parent ___ guardian or ___ conservator of ______, a minor, and as such do hereby authorize St. Patrick 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.

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. For good and valuable consideration, I hereby grant to St. Patrick Parish the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child ______(youth), or images in which me/my minor child may be included, now existing or hereafter made, in any case, with or without identifying subject for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. I release the staff and volunteers of St. Patrick 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.

Youth Permission and Travel Form

Youth Participant’s Name: ______

Insurance Carrier: ______

Policy Number: ______Insurance ID Number: ______

Social Security # (optional): ______

Medications: INITIAL All that Apply – Note: 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 self-administer 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. The child’s parent/guardian/conservator will provide and dispense any and all needed medications.

______No medication of any type whether prescription or nonprescription may be administered to this child unless the situation is life-threatening and emergency treatment is required.

______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 disabilities or 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? ______

Youth Permission and Travel Form

DCYC 2015 Parent/Guardian Signature Page

______

Youth Participant’s Name

______

Name of Parent/Guardian/Conservator 1

______

Parent 1 Primary Phone Number Parent 1 Secondary Phone Number (optional)

______

Name of Parent/Guardian/Conservator 2 (optional)

______

Parent 2 Primary Phone Number (optional) Parent 2 Secondary Phone Number (optional)

______

Name of additional Emergency Contact (optional) Phone Number (optional)

______

Signature of Parent/Guardian/Conservator Date Signed

PLEASE ATTACH A PHOTOCOPY OF YOUR HEALTH INSURANCE CARD, FRONT AND BACK

Last Name of Youth ______Page 1 of 5 Form update 201-02