Steubenville
Northwest
July 25 – July 28, 2013
Thursday through Sunday
Spokane, Washington
Add on option: INCREASE: July 29 & 30! See below.
1 John 4: 19
We love Him because He first loved us.
SILVERWOOD: Friday Morning/Afternoon at Silverwood
Theme Park! Included.
Steubenville Northwest Conference: Friday Night
through Sunday Noon at Spokane Convention Center
and Gonzaga University! Included.
INCREASE: Monday/Tuesday 2 day Service
Program in Spokane following Conference!
Optional ~ will decide as a group. See details inside.
Dear Parents and Students:
This summer of 2013, Saint Thomas the Apostle Youth Ministry will be attending Steubenville Northwest
in Spokane, WA, at the Spokane Convention Center and Gonzaga University. Steubenville Northwest is a
part of a nationwide Catholic Youth Conference series that ministers to over 33 thousand teens each
summer. We will begin our trip on Thursday, July 25th reserving it as a travel day and time to become a
team. Friday will consist of a ½ day at Silverwood Theme Park in Coeur D’alene, Idaho, and the start of
the Catholic Youth Conference that evening in Spokane. The Conference will continue through Sunday
noon. We then hope to take advantage of the new INCREASE program that involves serving those in need
of the Spokane area for through Tuesday noon. We will have a reflective drive home as we depart Spokane
Tuesday afternoon arriving in Billings late Tuesday night. We hope to share this wonderful experience
with as many of our teens as possible. Please review the details and feel free to call or write at any time
with further questions. My contact information is below.
Weekend Information:
Date: Thursday, July 25 through Sunday 28, 2013 with INCREASE Option on Monday and
Tuesday, returning home late Tuesday, July 30th.
Who: All teens going into 9th grade through graduating seniors.
Where: Spokane, Washington: Spokane Convention Center and Gonzaga University.
Cost: $400.00 (Including INCREASE $540.00). This fee includes: All meals, accommodations outside
of the conference, conference fee and accommodations, all activity entrance fees and ground transportation.
Not included: Snack money and spending money.
Fundraising:
At this time no fundraising events are scheduled. Please note that all transportation and gas will be
covered by our Mystic Monk Coffee fundraising that we hold throughout the year. Trying to keep
the cost down for you, this takes care of a large sum of your total. If INCREASE program included,
$540.00 is a great price for 6 days. Again, all transportation is covered. If you and your student do
fundraising on your own, I will be happy to assist you.
Important Due Dates:
Monday, April 8th: Information Meeting for students and parents at 7:00 PM in Youth Rm. We
will finalize INCREASE being a part of our trip or not.
Wednesday, April 15th: All Registration/liability/medical release forms and $200 deposit due.
Tuesday, May 15th: $200.00
Friday, June 15th: $140.00 Remaining balance due.
Note: All transportation costs, leased vehicles and gas or bus, are covered through our
Mystic Monk Coffee fundraising throughout the year! Thank you for your support!
Please make checks payable to: Saint Thomas the Apostle Catholic Church, Note: SNW
Please mail fully completed registration forms and funds to:
Saint Thomas the Apostle Catholic Church
Attn: Director of Youth Ministry
2055 Woody Drive
Billings, MT 59102
We are excited to participate in another Steubenville Catholic Youth Conference that changes lives forever.
This trip is fully loaded with a Catholic identity, fun, a time to form hearts of servants through the
INCREASE program, and for some, a once in a lifetime opportunity. Please pray for all involved and know
of our prayers for you.
Note: We have students that are in need of assistance. If you or someone you know would like to donate
any amount of funds towards their journey, it would be greatly appreciated.
In the Hearts of Jesus and Mary,
Cathy Day
Cathy Day, Saint Thomas the Apostle Director of Youth Ministry
Church: 406-656-5800 Ext: 312 Cell: 406-679-4473
Email: cathyd_stthomas@qwestoffice.net
DIOCESE OF GREAT FALLS-BILLINGS
Steubenville Northwest
July 26th – July 30, 2013
PARENTAL/GUARDIAN CONSENT FORM AND LIABILITY WAIVER
Participant’s Name: _____________________________________________________________
Birth Date: _____________________ Age: ____ Sex: _________________________________
Parent/Guardian Name: ___________________________________ Email: __________________
Home Address: __________________________________________________________________
Home Phone: __________________________ Business/Cell Phone: ______________________
Students Cell Phone: ______________________________________________________________
I,__________________________, grant permission for my dependent, ____________________, to participate in
this parish ministry event that requires transportation to a location away from the parish site. This activity will take
place under the guidance and direction of parish employees and/or volunteers from St. Thomas the Apostle and
other Catholic Parishes of the Diocese of Great Falls-Billings and the Diocese of Spokane, Washington, Gonzaga
University and Spokane Convention Center. A brief description of the activity or event follows:
Event: Steubenville Northwest, Catholic Youth Conference.
Location of Event: Spokane Convention Center and Gonzaga University.
Individual in Charge: Youth Director: Cathy Day from St. Thomas the Apostle Parish
Estimated time of departure & return: Meet/Departure July 25th: 8 AM. Return July 30th: 11 PM
Mode of transportation to and from event: Leased vehicles or bus.
As a parent and/or legal guardian, I remain legally responsible for any personal actions by the above named
minor (“participant”).
I agree on behalf of myself, my child name herein, or our heirs, successors, and assigns, to hold harmless and
defend St. Thomas the Apostle and other Catholic Parishes of the Diocese of Great Falls-Billings and the Diocese of
Spokane, Washington, Spokane Convention Center, Gonzaga University, its officers, directors and agents,
chaperones, or representatives associated with the event, arising from or in connection with my child attending the
event or in connection with any illness, or injury, or even death, or cost of medical treatment in connection
therewith, and I agree to compensate the parishes, its officers, directors and agents, the Diocese of Great FallsBillings and the Diocese of Spokane, Washington, Spokane Convention Center, Gonzaga University, chaperones, or
representatives associated with the event for reasonable attorney’s fees and expenses arising in connection
therewith. I also agree that if at any time directors, volunteers or chaperones of any of the above agencies agree
that a student’s inappropriate behavior requires them to be sent home, I will be responsible for all transportation
and costs and see that it happens in the time requested. I also agree to allow appropriate photos of my child taken
during this event to be used for sharing the event, advertising or promotion for future youth ministry events.
Signature: ___________________________________________ Date: ___________________
BOTH SIDES MUST BE COMPLETED AND SIGNED
MEDICAL MATTERS
I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of
my child. (Of the following statements pertaining to medical matters, sign only those that are applicable.)
Family Doctor: _______________________________________ Phone: _________________________________
Family Health Plan Carrier: __________________________________________ Policy #: ___________________
Parent Signature: ___________________________________________________ Date: ___________________
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for
emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the
event of an emergency, if you are unable to reach me at the above numbers, contact:
Name and relationship: ____________________________________________ Phone: ______________________
Other Medical Treatment: In the event it comes to the attention of the parish, its officers, directors and agents, and the
Diocese of Great Falls-Billings, chaperones, or representatives associated with the activity that my child becomes ill with
symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to
myself).
Parent Signature: ___________________________________________________ Date: ___________________
Medications: My child IS______ or IS NOT________ taking medication at present. My child has all such medications necessary
and medications are well-labeled. Names of medications and concise directions for seeing that the child takes such
medications, including dosage and frequency of dosage, are as follows:
_____________________________________________________________________________________________
Parent Signature: ___________________________________________________ Date: ___________________
_____NO MEDICATION OF ANY TYPE, whether prescription or non-prescription, may be administered to my child unless the
situation is life-threatening and emergency treatment is required.
Parent Signature: ___________________________________________________ Date: ___________________
_____I hereby grant permission for non-prescription medication (such as Tylenol, throat lozenges, cough syrup) to be given to
my child, if deemed necessary.
Parent Signature: ___________________________________________________ Date: ___________________
Specific Medical Information: The parish(es) will take reasonable care to see that the following information will be held in
confidence:
Allergic reactions (medications, foods, plants, insects, etc.) ________________________________________________
Immunizations. Date of last tetanus/diphtheria immunization: _____________________________________________
Any physical limitations: __________________________________________________________________________
Is child subject to chronic homesickness, emotional reactions to new situations, sleepwalking, bed wetting, fainting?
_______________________________________________________________________________________________
Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc? If so, date
disease or condition: _______________________________________________________________________
You should be aware of these medical conditions of my child: _____________________________________________
________________________________________________________________________________________________
and