Who’s it for: Everyone (under 18 must be accompanied by a parent or youth group leader) Who is in charge: Spiritual Director - Fr. Robb Jurkovich South/Central U.P. - Len McKeen (906-227-9117) North/West - Jen Lochner (906-226-6548 ext. 211) When: Tuesday, January 20—Saturday, Jan 24, 2015 Time: Buses leave in the late afternoon or early evening. A detailed bus schedule and itinerary will be provided after registration. Pick-up locations will be determined according to need. Cost: $245 - This price is made possible by a generous donation from the Legacy of Faith Grant Fund of the Diocese of Marquette. It includes two nights quad-occupancy lodging, charter bus, Yoopers 4 Life beanie and t-shirt, and a catered breakfast at Sacred Heart Seminary. What’s on the itinerary: Tuesday - Saturday pilgrimage to Washington D.C. including Wednesday Vigil Mass at the National Basilica. 28,000 participant Youth Rally Thursday morning at the Verizon Center, 300,000+ participant “March for Life” from the Washington Mall to the steps of the Supreme Court in defense of the unborn Thursday afternoon and Mass, breakfast, and tour at Sacred Heart Seminary in Detroit on Saturday morning. We will return home by early evening Saturday. How do I register: Contact Len McKeen or Jen Lochner by phone at the numbers above or email [email protected] to request a registration form. You may also download a registration form at the Yoopers 4 Life Facebook page. Deadline for registration is November 21. After Nov. 21 please call for the latest registration information. All participants under 18 years old must be accompanied by a guardian. Registration must be paid in full by December 15, 2014. CODE OF BEHAVIOR March for Life Pilgrimage This code of behavior has been developed as a way of helping participants understand what is expected of them during the event, and making the experience a healthy, positive, and worthy one for all involved. Please read through the code carefully, as you will be expected to honor and uphold it throughout your time with us.  We expect everyone to be a willing person who will work together for the common good in order to make this event successful.  Treat all facilities like your own home.  No visiting is allowed in sleeping areas occupied by the opposite sex. Further, men will be assigned to rooms with other men and women with women. The two exceptions to this rule are families and married couples.  Each day will be packed with activities, making adequate sleep a necessity. The noise level in the sleeping areas should be kept at a minimum.  There is no smoking/tobacco use in the building(s). (Smoking/tobacco use is allowed outside and only if you are of legal age.) Also, consumption of alcohol is both not permitted on the bus, and not permitted for those under the legal drinking age.  The purchase, possession or consumption of illegal drugs by participants will result in immediate dismissal from the pilgrimage. The possession of drug paraphernalia will also result in immediate dismissal. You will be dismissed and need to be picked up via your own personal contacts.  Please keep the members of the March for Life Pilgrimage leadership team aware of your attended location while on the pilgrimage in order to assist us in making sure everybody makes it home safely. For instance, if you decide to go sight-seeing, let us know so that we can know where to look if we need to find you.  No registration fee refunds can be given after December 15 th unless a substitute participant has been previously secured.  No foul language. I have read and agree to the above Code of Behavior: Name Printed Name Signed Date Photo/Recording Release Adult I give permission for any photograph, video, audio recording and/or likeness procured of myself to be used by the Diocese of Marquette. These may be used for promotional purposes including: diocesan websites, The U.P. Catholic newspaper, and other materials produced by the diocese. I understand and agree that the use of my photograph, video or audio recording, and/or likeness is not an invasion of privacy. Neither I nor anyone claiming to be speaking on my behalf will object to the Diocese of Marquette using this material. Signature Date Parent/Guardian I give permission for any photograph, video, audio recording and/or likeness procured of my child(ren) to be used by the Diocese of Marquette. These may be used for promotional purposes including: diocesan websites, The U.P. Catholic newspaper, and other materials produced by the diocese. I understand and agree that the use of their photograph, video or audio recording, and/or likeness is not an invasion of privacy. Neither I nor anyone claiming to be speaking on my behalf will object to the Diocese of Marquette using this material. Parent/Guardian signature Date INSTRUCTION Field Trips Page 1 of 3 6153 FF Parent Permission Form For Field Trip Participation (This form must be completed by parents or guardians of participants 17 or younger) Dear Parent or Legal Guardian, Your son/daughter is eligible to participate in a parish-sponsored activity requiring transportation to a location away from the parish grounds. This activity will take place under the guidance and supervision of adult chaperones. A brief description of the activity follows: Name of Event: 2015 March for Life Pilgrimage Destination: Washington, D.C. Designated Supervisor of Activity: Fr. Robb Jurkovich, Spiritual Director of Yoopers 4 Life Date and Time of Departure: Tuesday, January 20, 2015 (Departure times and places vary) Date and Anticipated Time of Return: Early evening on Saturday, January 24, 2015 Method of Transportation: Charter Bus Participant Costs: $245.00 If you would like your son/daughter to participate in this event, please complete, sign and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for the actions and conduct of your child. I hereby consent to participation by my son/daughter _________________________________________ in the event described above. I understand that this event will take place away from the parish grounds and that my son/daughter will be under the supervision of designated parish employees on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation. In consideration of my child being allowed to participate in this field trip, I hereby agree on behalf of myself and my child, to release Escanaba Catholic Faith Formation, the Roman Catholic Diocese of Marquette, and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively “Releases”) from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child’s participation in the field trip. In the event this release on behalf of myself and/or my child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releases from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child’s participation in the field trip. This release or indemnification does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any claim, but this Release or Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim. (Print Parent's Name) (Parent's Signature) (Date) INSTRUCTION Field Trips Page 2 of 3 6153 FF EMERGENCY MEDICAL TREATMENT RELEASE FORM (All participants must fill-out this form) To Whom It May Concern: As an adult of at least 18 years or as a parent/guardian of a minor, I do hereby authorize the treatment by a qualified and licensed Medical Doctor in an emergency which, in the opinion of the attending physician, may endanger my life or the life of the student, cause a disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to establish my consent or reach me respectively. Name of Adult or Minor______________________________________________ Relationship to you _________________ Reason for which release is intended ____________________________________________________________ Address of Adult or Minor ____________________________________ Phone__________________________ Emergency Phone ___________________________________________________________________________ Family Physician ____________________________________________ Phone_________________________ Address_____________________________________________ City ______________ List allergies, medication, contacts, or other pertinent information: Health Insurance Data: Company __________________________________________________ Policy____________________________ Group ________________________________ Contract_______________________ This Release Form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. ____________________________________________________________________________________________ Sign Name (Parent or Guardian if under 18) (Date) March for Life Pilgrimage – General Registration Form (All participants must fill-out this form) Name_____________________________________________________ Age ___________________ Sex____________ Address__________________________________________________________________________________________ Street City State ZIP Phone ( ____ ) _____________________ E-mail _________________________________________________________ Roommate Request (Reminder: men will be assigned to rooms with other men and women with women. A duo-occupancy upgrade fee may be paid by MARRIED couples who would like to room together or in the case of a child with a relative. Also, families may room together (no additional beds are allowed in the two bed rooms according to Washington, DC ordinance. If a family wants to room to together and has more than four members, please keep this in mind) Please mark the box that applies to your rooming preference: I have no preference. Please assign me hotel roommates at your direction. Please assign me to a room with the following participants (one, two, or three name slots may be filled-in): 1. ___________________________________ 2. ___________________________________ 3. ___________________________________ My wife and I would like to room duo-occupancy. We understand that the total cost of registering duo-occupancy is $690 (245 + 245 + 200 duo-occupancy upgrade). Name of spouse __________________________________ I am registering for $345 so that I can have my own bed (I understand that I will be assigned up to two roommates). My roommate preference is (if no preference then leave blank): 1. _______________________________________________ (If applicable) 2. _______________________________________________ I have enclosed only $____________because I cannot afford the full registration amount. Please contact me about scholarship opportunities. I have enclosed a $50 deposit to hold my spot. I will pay in full by ________________. (date) T-Shirt Size (Adult Sizes) Circle One: XXL XL L M S XS Are you interested in attending the March for Life Youth Mass at the Verizon Center? Yes No If under 18, who will be your guardian while in Washington, D.C.? Name : _____________________________________________________________________ Relationship to you: Parent Youth Leader Other, Explain ____________________________________________ Church Information: Name of Church and City, State _____________________________________________________________ Registration Deadline: November 21, 2014. After Nov. 21 please call ahead (906-227-9117). Full payment is due no later than December 15. Make Checks payable to: Yoopers 4 Life Refund Policy: Until November 21 full refunds will be given upon request. After November 21 refunds (less $50 deposit) will be given only if a replacement participant can be found. After January 1st no refunds will be given. In extenuating circumstances, we'll see what we can do. ---------------------------------------------------------------------------------------------------------------------------------------------------- For Office Use Only: Date Received: _________________ Deposit: _____________________ Paid in Full: ________________