1. Indianapolis Catholic Youth Conference
November 7, 2010
“PURSUIT OF GLORY”
Youth Registration Form
Name (Printed):__________________________________________ Home Phone: (_____)_________-_________________
Address:_________________________________________________ City:____________________State:_______Zip:___________
Email Address:____________________________________________ DOB:____/____/____ Gender (Circle One) Male Female
Parish:___________________________________________________ School Affiliation: ___________________________________
Health Insurance Company:_________________________________ Policy Number: _____________________________________
Allergies, medical conditions or special needs:_______________________________________________________________________
T-shirt Size (Circle One) S M L XL 2XL 3XL
Mega-Session/Workshop Choice (see Mega-Session and Workshops descriptions sheet):
(1)________________________ ____________________________
Please make 2 choices for each round (2)_________________________ ____________________________
PARTICIPATION CONSENT:
I grant permission for my child to participate in the Indianapolis Catholic Youth Conference. I will not hold the
Archdiocese of Indianapolis, Diocese of Lafayette, or Bishop Chatard High School responsible in the event of any injury or accident
to my son or daughter while participating in the conference, and/or traveling to and from the event. I warrant that, to the best of my
knowledge, my child is in good health and able to participate in all program activities. (Please submit a statement indicating
limitations and/or conditions of which we should be aware.)
I agree that my child shall abide by the Youth Code of Conduct.* I have reviewed and discussed the Code with my child
prior to signing this form. I agree to my child’s participation, and that if my child fails to abide by the Code or engages in a serious
infraction of the Code, he or she may be immediately dismissed from the event with no refund, and sent home at my expense.
In case of medical emergency, I understand that every effort will be made to contact parents or guardian of participants. In
the event that I cannot be reached, I hereby give permission to the Youth Ministry program directors to seek treatment for my
son/daughter. I hereby give permission to the medical staff to hospitalize, secure proper treatment for, and to order injection,
anesthesia, or surgery for my child.
I understand that my child may be photographed, unidentified in group situations; and I hereby grant permission for my child
to be photographed & identified for releases to The Criterion and/or Archdiocesan website and/or other promotions.
Archdiocesan Youth Code of Conduct*
 Participants are expected to partake in assigned activities and wear their name tags during all program activities.
 Dress during the rally is casual. Jeans, T-shirts, etc., are fine. Clothing with offensive or obscene words, pictures, symbols, etc.
is not acceptable. Shirts and shoes must be worn at all sessions and meals. No halter tops, tank tops or sleeveless shirts are
allowed. Shorts or skirt lengths must be appropriate (when a person is standing straight with arms hanging to side, shorts or skirt
must meet or pass their fingertips). Pants must not sag, or a belt will be provided.
 Language and conduct should reflect the values we proclaim as Catholics.
 Participants are to remain with their group at all times during the rally unless accompanied by adult chaperones. An exception is
during Mega-Sessions and Workshops.
 Socializing will take place only in the designated common areas of the high school.
 Smoking and the use of tobacco products is not allowed by any participants during the event. Violation of this rule will result in
immediate dismissal from the conference.
 The possession or use of alcohol, illegal drugs or weapons will not be tolerated. Breaking this rule will mean immediate
dismissal from the event. (Parents will be called.)
 Please avoid the use of cell phones/pagers or other electronic devices during the sessions and Mass.
Parent/Guardian (Print): __________________________________ Signature: _______________________________________
Emergency Phone: _________________________________________Alternate phone: ________________________________
Youth Signature:__________________________________________ Date:____________________________________________
Cost for the youth is $40. Deadline for registration is _____________________________________.
Return this form to your parish or school! All participants need to register through their parish or school!