C O Ntagious Flyer Reg Oct11


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TJUC registration deadline is 10/7/11. Please submit forms and fees to DRE Barb.

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C O Ntagious Flyer Reg Oct11

  1. 1. CONtagious 2011 Heartland Districts 5th Annual YRUU Kickoff Con! Get excited about the DYSC conference season at CONtagious with... CON BANDS - Small assigned groups designed to help newcomers and old comers alike get to know people WORKSHOPS - Play games, watch and discuss movies, learn about social justice, and much more CAUGHY HAUS - A goofy talent show where youth and adults present their wacky and amazing talents WHEN: October 21-23, 2011 WHERE: Unitarian Universalist Church of Indianapolis 615 West 43rd St., Indianapolis, IN 46208 www.UUI.org WHO: Senior High Youth (9-12th grade) and their advisors Check-in starts at 7:00pm on Friday TJUC REGISTRATION IS TO DRE; DEADLINE- OCOTBER 7TH Fee: $40.00PLEASE PAY FEE BY CHECK MADE OUT TO HEARTLAND DISTRICT Email your questions or concerns to: Will Taylor will.taylor@insightbb.com or Karalyn Grimes at karalyngrms@gmail.com IF YOU REGISTER ONLINE AND PAY BY CREDIT CARD,PLEASE PRINT A COPY OF YOUR REGISTRATION AND PAYMENT Register online & pay by credit card at: http://www.heartlanduu.org/conferences_workshops.html
  2. 2. CONtagious REGISTRATION FORM OCTOBER 21-23, 2011Senior High Youth and Adult Youth Advisors must complete and submit the form below to register for all youth conferences in the Heartland District.Registration Type (circle one): youth adult staffGrade Level: ___________Age: ________ Birth Date (mm/dd/yy): ___/___/________First Name: ____________________________Last Name: ______________________________ Address: ______________________________________________________________________City: ______________________________________St: ________Zip: _____________________Name of parent/guardian at this address: ____________________________________________Phone #: (____) _______-_______________Email: ____________________________________Congregation/Church/Fellowship: __________________________________________________Dietary Preference (circle one): omnivore vegetarian vegan# of Cons Attended (circle one): 1 2 3 4 5 6 7 8 9 10+I am interested in receiving a scholarship (circle one): YES NORegistration Fee Paid: $_________How will fee be paid (circle one): check by mail online with credit card staff-not applicableI have read the Conference Rules and Code of Ethics/Conduct (circle one): YES NODate submitted: _________________________ PLEASE COMPLETE THE YOUTH PERMISSION AND HEALTH FORMS BELOW AND GIVE TO REGISTRAR WHEN CHECKING INTO THE CONFERENCE.
  3. 3. CONTAGIOUS PERMISSION & SUPERVISION FORM OCTOBER 21-23, 2011 (Please complete and present form to registrar when signing in at the conference.)Date: ___________________________Attendee Name: ____________________________________________________________Congregation: ____________________________________________________________YOUTH: List adult sponsor(s) attending from your church:1.___________________________________________2.__________________________________________3.___________________________________________4.__________________________________________I have read and will uphold the Youth Conference Rules. If I do not follow these rules, I may be expelled from theconference.Signature: ___________________________________________ Date: _________________PARENT/GUARDIAN: In the event that my child is asked to leave the conference, I accept all responsibility for thesafe removal of my child. My child has my permission to ride to and from the conference with the followingpersons:1.___________________________________________2.__________________________________________Signature: ___________________________________________ Date: _________________ADULT SPONSORS: I have read and will uphold the Youth Conference Rules. If I do not follow these rules, I maybe expelled from the conference.Signature: ___________________________________________ Date: _________________List the names of youth under your supervision while attending this Conference:1.___________________________________________2.__________________________________________3.___________________________________________4.__________________________________________5.___________________________________________6.__________________________________________7.___________________________________________8.__________________________________________9.__________________________________________10.__________________________________________
  4. 4. Youth Conference Rules and Code of Ethics (Must be read and signed by all Adult Sponsors and Older Youth in Leadership Roles)Rules: All rules apply equally to youth and adults. All rules were formed by the DYSC for liability reasons andconferee safety. Enforcement of the conference rules is the responsibility of EVERY conferee with overallsupervision by the DYSC officers. Adults in general are not expected to be the primary rule enforcers, but areexpected to be full conference participants. Adults and youth leaders are expected to serve as good role modelsand to have a signed code of ethics when they check in at conferences. At least 1 adult per 10 youth from each church must be present (1-7Attendees will remain on site at all times for Jr. High events)Being outside designated areas at any time is Illegal use of alcoholic beverages, illegal drugs and weapons areprohibited prohibitedNO SEX! Everyone must attend all mandatory planned activitiesCaffeine pills and other unnecessary drugs (Sleeping area rules would go here, but we don’t intend onare not allowed sleeping!)Smoking is not condoned during the Sexual behavior which detracts from the conference communityconference for youth or adults will not be toleratedAdhere to site rules Cars are off limits during the con except for approved con businessIn the event of a rules infraction, the Conference Rules Committee will be convened to determine theconsequences of the rule infraction. Code of Ethics for Adults, Older Youth and Youth in Leadership Roles with Youth Based on the Code of Ethics for Adults, Older Youth, and Youth who are in leadership roles with Children and Youth, adopted by the Unitarian Universalist Association in 1986.Adults, older youth, and youth who are in leadership roles are in a position of stewardship and play a key role infostering the spiritual development of both individuals and the community. It is therefore especially importantthat those in leadership positions be well qualified to provide the special nurturing, care and support that willenable youth to develop a positive sense of self and a spirit of independence and responsibility. The relationshipbetween young people and their leaders must be one of mutual respect if the positive potential of theirrelationship is to be realized. There are no more important areas of growth than those of self-worth and thedevelopment of a healthy identity as a sexual being. Adults play a key role in assisting youth in these areas ofgrowth. Wisdom dictates that youth and adults suffer damaging effects when leaders become sexually involvedwith young persons in their care; leaders will therefore refrain from engaging in sexual, seductive or eroticbehavior with youth. Neither shall they sexually harass youth nor engage in behavior with youth that constitutesverbal, emotional or physical abuse. I, _______________________________________, as a youth leader, an olderyouth (over 18) or an adult, recognize my position of power and have read and understand the above statementsof position, expectations and actions and agree to follow the Code of Ethics.**Signature: __________________________________________________Date:___________
  5. 5. CONtagious EMERGENCY FORM OCTOBER 21-23, 2011 (To be filled out by all Conference Attendees)Attendee’s Name: _________________________________________________________________Name of Parent(s)/Guardian(s): _______________________________________________________Parent(s)/Guardian(s) Phone # (____) _____________________Physician: ____________________________________ Phone #: (_____) _____________________Insurance Company: _______________________________________________________________Policy Holder: __________________________________ Policy #: ____________________________Allergies: ______________________________________________________________________Health Conditions: ________________________________________________________________Please list any medications you are taking (and reason):______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list two people, other than parents, that we can contact in an emergency who can legally provideauthorization for medical treatment.Name: _____________________________________________ Phone: (____) __________________Name: _____________________________________________ Phone: (____) __________________Please check one of the following and sign:_____I Request Medical Treatment for my child without prior notification._____I Request NO Medical Treatment for my child without prior notification.In the event of an emergency, I understand that the DYSC/Heartland District will try to contact me. If I am unableto be reached, the DYSC/Heartland District will do their best to ensure the safety and health of my child,__________________________________________________________________.(Insert child’s name)I do not hold the District Youth Steering Committee, the Heartland District, or the host church liable in the eventof an emergency.Signature of Parent/Guardian: ______________________________________ Date: ____________________