JUNIOR HIGH WORKCAMP 2014
July 23-26, 8:30 am-8:00 pm (Wednesday, 6-8 pm)
St. James Catholic Church  St. Mary of Sorrows Catholic Church
St. Mark Catholic Church  St. Leo the Great Catholic Church
For:
Any rising 7th, 8th, and 9th graders interested in participating in a local service experience.
MUST turn in Registration Form by July 18th to participate!
Location:
All activities will begin and end at:
St. Leo the Great Catholic Church
3700 Old Lee Highway
Fairfax, VA
Form and payment due by July 18th!
No late registrations will be accepted.
Meals:
Breakfast, dinner, and snacks provided.
Please bring your own bag lunch for Thursday, Friday, and Saturday.
Fee:
$70 for each participant (Checks made out to St. Mary of Sorrows). T-shirt included.
Parents Must Attend: Parent Info Night on Thursday July 10, 2014 at 7:00pm in the Farrell Hall at St. Mary’s
Questions?
Contact Maddy Bernero at maddyb@stmaryofsorrows.org or 703-978-4141 ex: 70.
Participant’s Last Name
Participant’s First Name
Street Address
City
Home Phone
Parent Email Address
Cell Phone (Father)
Cell Phone (Mother)
Date of Birth (MM/DD/YY)
Gender
State
Grade for 2013/14 School Year
Zip
Adult T-Shirt Size
Participant's Commitment:
I hereby make a personal commitment to participate fully in the event described above and to abide by the standards of
conduct established by Saint Mary of Sorrow’s Parish and all participating parishes and their representatives.
________________________________________
Signature of Participant
______________________________
Date
Parental Permission and Liability Release:
As parent/legal guardian of the participant named above, I (we) do hereby give my (our) permission for him or her to
participate fully in the event described above. I (we) do for myself (ourselves) and for and on behalf of my (our) child
(referred to here as "participant") do release, forever discharge and agree to hold harmless Saint Leo Church and/or St. Mary
of Sorrows Church and/or St. James Church and/or St. Mark Church, its directors, employees, and agents thereof from any
and all liability, claims, and demands for personal injury, sickness and death, as well as property damage and expenses of any
nature whatsoever which may be incurred by the undersigned or the participant resulting from said participant's involvement
in the above described event (including transportation between the participant's home, Saint Leo's Church, and the event
location). Furthermore, I (we) on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage,
and expenses resulting from said participant's involvement in the above described event.
Further, authorization and permission are hereby given to St. Leo Church and/or St. Mary of Sorrows Church and/or St. James
Church and/or St. Mark Church, its directors, employees, and agents thereof to furnish any necessary transportation, food, or
lodging for the participant while he or she is involved in the above described event.
(SEE BACK SIDE)
Parental Permission and Liability Release - continued:
I (we) hereby authorize St. Leo Church and/or St. Mary of Sorrows Church and/or St. James Church and/or St. Mark Church, its
directors, employees, and agents thereof to admit the participant to a doctor, hospital, or other licensed health care provider
for medical treatment and assume full responsibility for all costs of such treatment. Further, should it be necessary for the
participant to return home due to medical, disciplinary, or other reasons I (we) do hereby assume responsibility for the
participant's transportation home and any costs related thereto.
________________________________________
Signature of Parent/Guardian
______________________________
Date
Emergency Contact:
(Provide name and phone number of two persons who should be contacted in case of emergency)
1. Name: _________________________________________
Phone: ______________________________
2 Name: _________________________________________
Phone: ______________________________
Health Information:
Are there any conditions or allergies, which may affect the participant's involvement in the above described event?
__YES __NO If Yes, please explain:
_____________________________________________________________________________________________________________________
Is there any physician prescribed or other medication which the participant may be taking during the above described event?
__YES __NO
If Yes, please provide name and frequency of medication:
_____________________________________________________________________________________________________________________
Does your child have any dietary restrictions?
__YES __NO
If Yes, please explain:
_____________________________________________________________________________________________________________________
Name and Phone of Physician or
Primary Health Care Provider:
Health/Medical Insurance
Coverage:
_______________________________
______________________________
I (we) understand and hereby agree to the terms and conditions of the participant's involvement in the above described
event.
____________________________
Parent Name
Please turn in form and check for $70
to the front office: attn Maddy
Bernero
____________________________
Parent Signature
St. Mary of Sorrow’s Catholic Church
5222 Sideburn Road
Fairfax, VA 22032
Due by July 18th!
JUNIOR HIGH WORKCAMP
2014
Parent Involvement Form
This week will be a memorable experience for your child. In order for this camp to happen, your
involvement is absolutely necessary. The scope of this program calls for everyone’s help.
Please fill in the blanks of role(s) that you will be willing to actively fill. Please take into consideration
that some roles are more or less time consuming than others.
Name___________________________________
Best Phone:__________________________
Email:_______________________________
___ Crew Leader (10-15 needed)
-Must be present at entire WorkCamp (Wed. night thru all day Sat.)
-Must attend Crew Leader Training Day, Saturday July 19, 9:00am to Noon (Mass and Lunch included)
-Assigned to 4-5 kids making up your crew
-Will drive crew to and from work site and work with them throughout the day
-No experience necessary just desire to work with these kids
How many passengers can your vehicle take? _____
-If you volunteer as a crew leader, your child will be reserved a spot!
___
Food Committee
Check all that you are available for. You will only be scheduled to help 1 time.
___ Wednesday evening snack (7:45 pm)
___ Thursday breakfast (8:45 - 9:45 am)
___ Thursday afternoon snack (3:30 - 4:30 pm)
___ Thursday dinner (5 - 6:15 pm)
___ Friday breakfast (8:45 - 9:45 am)
___ Friday afternoon (3:30 - 4:30 pm)
___ Friday dinner (5 - 6:15 pm)
___ Saturday breakfast (8:45 - 9:45 am)
___ Saturday snack (1:45 - 2:30 pm)
___ Saturday BBQ (4:30 - 7 pm)
____ Decorations, Set-up, and Clean-up Committee (8-10 people)
-Decorate St. Leo’s gym, Wednesday from 4 - 5:30 pm.
-Help with Clean-up on Saturday after Barbecue.
Thank You!
Junior High WorkCamp 2014 cannot be a success without your involvement.
Please return this form to Maddy Bernero at the front office at St. Mary of Sorrows.
For more information, contact Maddy Bernero at maddyb@stmaryofsorrows.org or 703-978-4141 ex: 70.
May God Bless You and Your Family!
Please keep for your records!
JUNIOR HIGH WORKCAMP
2014
July 23-26, 8:30 am-8:00 pm (Wednesday, 6-8 pm)
St. James Catholic Church  St. Mary of Sorrows Catholic Church
St. Mark Catholic Church  St. Leo the Great Catholic Church
For:
Any rising 7th, 8th, and 9th graders interested in participating in a local service experience.
Location:
All activities will begin and end at:
St. Leo the Great Catholic Church
3700 Old Lee Highway
Fairfax, VA
Form and payment due by July 18th!
No late registrations will be accepted.
Bring:
Comfortable work clothes, sneakers, a bag lunch, sunscreen, water bottle, basic tools according
to site, and a good attitude. No Flip Flops or electronic devices!
Meals:
Breakfast, dinner, and snacks provided.
Please bring your own bag lunch for Thursday, Friday, and Saturday.
Fee:
$70 for each participant (Checks made out to St. Mary of Sorrows). T-shirt included.
Parents Must Attend: Parent Info Night on Thursday July 10, 2014 at 7:00pm in the Farrell Hall at St. Mary’s
Questions?
Contact Maddy Bernero at maddyb@stmaryofsorrows.org or 703-978-4141 ex: 70.
Parent Program & Dinner
After 5pm Mass
Saturday, July 26 at 6:00 pm