Our Mission Trip provides service opportunities to restore homes and HEARTS: feed the hungry, lift the spirits of children, bring joy to the elderly and disabled, and offer assistance, in addition to laughing until your side hurts, singing & dancing

uncontrollably, and making new friends from across the country!

Registration Forms can be found: in the Teen Room, PREP Office, Church Office, Wooden Kiosk in Church Narthex, & ONLINE at

www.maryofvernon.org/youth-ministry

2019 SUMMER MISSION TRIP HOMEBASE Archbishop Bergan Catholic School 545 East 4th Street Fremont, NE 68025 Saturday, June 22nd – Saturday, June 29th

What is a Mission Trip? It’s an 8-day adventure filled with SERVICE, LAUGHTER, and PRAYER.

A week of Workcamp is not an easy feat, but in the end your tired body will have a renewed spirit, ready to continue loving and serving others.

“This summer, we gather to celebrate our call to be radiant followers of Christ. We will love as He loved, serve as He served, and boldly put our faith into action. James 1:22 reminds us that we are to be “doers of the word and not merely hearers”. By letting our light shine bright and being witnesses for Christ. We recognize that we are designed in His image and, as a result, equipped for greatness.

We are called to illuminate our Catholic faith in our lives and the lives of others through our words and deeds. Each of us can be a source of light to a darkened world when we lead with love and keep our eyes fixed on Jesus, for He assured us in John 8:12 when He said, “I am the light of the world, He who follows me will not walk in darkness, but will have the light of life.”

With these words at heart, we invite you to join Catholic Heart Workcamp in our mission to serve with radiant spirits as we embrace the exciting truth that we are called to Illuminate.”

For the 2019 Mission Trip we have registered for a “Next Level Workcamp”. In addition to the service work, there will be live music every morning and night, games and activities, Eucharistic Adoration, daily Mass, and a chance to meet tons of new people. The relationships you form can be life changing. In short, we will work hard, play hard and pray hard; and you will be changed by the experience.

Our group of 40 will be at a “camp” with about 230 other “campers” from Catholic churches around the U.S. All the “campers” are divided into random work groups of 6 teens (not necessarily all from St. Mary of Vernon). There are always one or two adult chaperones assigned to each group that stays with the teens to supervise and guide them throughout each work day.

Catholic HEART Workcamp is committed to doing everything to ensure the safety of all those employed by and attending a Catholic HEART Workcamp. CHWC completes a National FBI Background Check on all employees. All CHWC Staff are also trained in the Virtus program “Protecting God’s Children” in order to be in compliance with the US Catholic Bishops Charter for the Protection of Children and Young People.

Chaperones and teens 18yr old and older going on the Mission Trip must be in compliance with

the “Protecting God’s Children” requirements as well. A 3-hour training will need to be completed along with some online forms. We will contact those who need to complete these requirements.

There will be additional meetings (probably three) spread out over the months leading up to the Trip. At these gatherings we will begin to prepare for our service experience, and we will start to get to know one another better. We hope that the teens and adult chaperones will do their best to attend these very important gatherings.

Due to the fact that Catholic Work Camp has raised the price of their Mission Trips, the cost of the 2019 Mission Trip is $530 if you register by February 2, 2019. The cost goes up to $580 for any registrations turned in after February 2nd.

We invite YOU into our mission this summer to illuminate Christ’s love in communities across

the country. St. Mary of Vernon will be taking campers entering the 9th grade in the fall of 2019 through college students. It is expected that each student participating in the Mission Trip will work a minimum of three fundraisers. The cost of their Trip will be deducted by $50 for each fundraiser they work (a maximum of three fundraisers).

Matthew 20:28

Fundraising Opportunities Scouts Christmas Tree Lot (November 23- December 23)- While working at the Scouts Christmas Tree Lot, you can raise money to be used towards your summer mission trip. Please see the additional Christmas Tree Lot rules sheet for more information.

Bake Sales (February 16 & 17, April 27 & 28)- All Mission Trip attendees are REQUIRED to make food items for BOTH bake sales. The more cupcakes, cookies, cakes, chocolate dipped pretzels, pies, banana bread, etc. we have, the more we can sell. All food must be dropped off prior to the 5:00pm Saturday Mass to sell for the weekend. We will need teens to work at each Mass selling the baked goods. Lenten Fish Frys (March 8, March 15, & April 5)- We need teens to work at the Friday night Fish Frys, busing tables and helping with clean-up. This will be done in 45-minute shifts. Stock Sales (June 1 & 2, 8 & 9)- We need teens to work at each Mass selling “Mission Trip Stock.” Purchasing stock allows people who cannot physical go with us to be with us in spirit. We send them a postcard while on our trip, and once we get back, we host a dinner for all the Stockholders. At that time, we thank them and share some of our trip experiences.

Car Wash (July 14, rain date July 21)- For this event to be successful, we need ALL teens to work washing cars while parishioners attend Sunday Mass. Please put these dates on your family calendar now. We will send out a SignUp Genius to sign up for time slot closer to the event date.

Friends & Family Donation Request Letter (optional – See the form letter in this packet)

Parent Volunteer Positions

If you volunteer, and follow through as a Coordinator for one of these Fundraisers, you will receive a $50 discount on the Mission Trip cost. Parent Volunteers are asked to attend the event for the entire time to oversee the teens working.

❖ One Coordinator for the first Bake Sale - (February 16 & 17) ❖ One Coordinator for the second Bake Sale - (April 27 & 28) ❖ One Coordinator for the first Stock Sale - (June 1 & 2) ❖ One Coordinator for the second Stock Sale - (June 8 & 9)

Stockholder Dinner

Our Annual Stockholder dinner will be Wednesday, July 17, 2019. This a potluck dinner where each Mission Trip attendee needs to bring a side dish or dessert to share (an SignUp Genius will be sent out requesting dishes). All Mission Trip attendees and families are encouraged to attend, along with our Stockholders. This is our way of saying “Thank You!” to our Stockholders for supporting us.

First Day of Workcamp Sunday12:00 - 2:30 Registration2:45 Arrive in program area

Welcome, opening comments, break into teams, icebreakers, team role handouts. Go to designated task training session toreceive more information about team role assignments.Hand out WORK DESCRIPTION ASSIGNMENTS and look them over.Agency representatives will be available to answer questions.

ADULT MEETING BEFORE DINNER (adults will eat dinner after the meeting)5:15 Dinner6:30 Arrive in program area:6:45 Active learning activities8:30 Eucharist celebration

Free time10:30 Go to rooms and get ready for bed11:00 Lights out

Day 2 Monday5:45 Staff arrives in kitchen to prepare breakfast6:15 Campers rise and shine6:45 Breakfast7:30 Morning Program (music, mass, prayer/share leaders)8:15 Get ready to leave, pick up supplies/lunches, etc. meet at vehicles & go to worksites8:45 Arrive at worksite12:00 Lunch and Prayer/Share time12:45 Back to work2:45 Clean up and get ready to leave sites3:00 Leave sites

Return to school, shower & free time, skit practice, relax, and sleep4:30 Mandatory adult meeting for parish contact person only Pick–up youth group activity4:30 Rosary offered5:00 Parish doing evening skit, meet with staff member5:15 Dinner6:00 Prepare lunches (Break Coordinators)7:00 Evening program : Carpenter Commandos, announcement character, up beat sing along music, praise & worship songs,

skit/drama presentation by youth, message, team reports, and pictures of day's workPray and share as a youth group (activity provided by CHWC)Free time

10:30 Go to rooms and get ready for bed11:00 Lights out

Day 3 Tuesday5:45 Staff arrives in kitchen to prepare breakfast6:15 Campers rise and shine6:45 Breakfast7:30 Morning Program (music, mass, prayer/share leaders)8:15 Get ready to leave, pick up supplies/lunches, etc. meet at vehicles & go to worksites8:45 Arrive at site12:00 Lunch and Prayer/Share time12:45 Back to work2:45 Clean up and get ready to leave sites3:00 Leave sites

Return to school, shower & free time, skit practice, relax, and sleep4:30 Mandatory adult meeting for parish contact person only Discuss Adoration4:30 Rosary offered5:15 Dinner6:00 Adult practice for “SKIT”7:00 Evening program : Carpenter Commandos, announcement character, up beat sing along music, praise & worship songs,

skit/drama presentation by youth, message, team reports, and pictures of day's workAdorationFree time

10:30 Go to rooms and get ready for bed11:00 Lights out

NEXT LEVELCATHOLIC HEART WORKCAMP DAILY SCHEDULE

Day 4 Wednesday5:45 Staff arrives in kitchen to prepare breakfast6:15 Campers rise and shine6:45 Breakfast7:30 Morning Program (music, mass and prayer/share leaders)8:15 Get ready to leave, pick up supplies/lunches, etc., meet at vehicles & go to worksites8:45 Arrive at sites12:00 Lunch and Prayer/Share time12:45 Back to work2:45 Clean up and get ready to leave sites3:00 Leave sites

Return to school, shower & free time, skit practice, relax, and sleep4:00 Mandatory adult meeting to explain “Four Corners” Prayer experience4:30 Rosary offered5:00 Dinner6:00 Prepare lunches (Break Coordinators)6:30 Evening program : Carpenter Commandos, announcement character, up beat sing along music, praise & worship

songs, skit/drama presentation by youth, message, team reports, and pictures of day's workFour CornersPray and Share as a Youth GroupFree time

10:30 Go to rooms and get ready for bed11:00 Lights out

Day 5 Thursday5:45 Staff arrives in kitchen to prepare breakfast6:15 Campers rise and shine6:45 Breakfast7:30 Morning Program (music, mass, prayer/share leaders)8:15 Get ready to leave, pick up supplies/lunches, etc. meet at vehicles & go to worksites8:45 Arrive at sites12:00 Lunch and Prayer/Share time12:45 Back to work2:45 Clean up and get ready to leave sites3:00 Leave sites

Return to school, shower & free time, skit practice, relax, and sleep.5:00 Rosary offered5:45 Parish doing skit, meet with CHWC Staff Member6:00 Mandatory adult meeting for parish contact person only Free Day Info & Pick-up Youth Group Activity6:00 Dinner7:00 Evening program: Residents are invited to share a few words , Carpenter Commandos, announcement character,

upbeat sing along music, praise & worship songs, skit/drama presentation by youth, message, team reports, andpictures of day's workPray and share as a youth group (activity provided by CHWC)Free time

11:00 Go to rooms and get ready for bed11:30 Lights out

Day 6 Friday Free Day: Morning Program7:00 Campers rise and shine7:30 Breakfast8:00 Morning Program: Summary video, Closing Liturgy, Announcements and house cleaning comments, Final comments10:00am Depart for free day10:30pm Return from free day (earliest time to return 8:00pm)11:00 Go to rooms and get ready for bed11:30 Lights out

Day 7 Saturday Departure Day7:00 Rise and shine

Clean-up rooms (Each room provided with plastic trash bags to collect trash and deposit in dumpster)8:00 Pack up9:00 Depart and start getting ready for next summer’s HEART Workcamp

LOVE * SERVE * CONNECTPLEASE NOTE: BREAKFAST WILL NOT BE SERVED DAY OF DEPARTURE.

FRIENDS & FAMILY DONATION REQUEST LETTER

Dear ______________________:

I hope this letter finds you well.

I have an opportunity this summer, to join St. Mary of Vernon’s Youth Ministry, as well as other

churches and youth groups from around the United States, on a mission trip to Fremont, Nebraska,

through Catholic Heart Workcamp. Let me briefly tell you a little about Catholic Heart Workcamp whose

mission is twofold.

First: To share the love of Jesus and serve the neglected, brokenhearted and marginalized in any way

needed. The Catholic Heart Workcamp mission is to revitalize communities and beautify homes for the

elderly, disabled and those who cannot afford needed repairs. Their goal is to inspire participants to serve

in their local communities as well.

Second: To empower participants to live as Disciples of Christ through serving others. To foster the

spiritual growth of each participant through the sacraments, Catholic faith sharing and prayer.

What I hope to personally gain from this mission trip is _______________________ .

The cost for students to participate in the Mission Trip is $530/$580 per student depending on when I

register. This includes a $125 deposit which I have paid in advance in order to hold my spot. Any

additional funds which I raise will go towards the general mission trip expense fund which helps to pay

for transportation (van rentals and gas), lodging, food/meals, camp T-shirts, work tools and various other

miscellaneous expenses.

If you would be willing to help sponsor me and the St. Mary of Vernon Catholic Church Youth Ministry

2019 Mission Trip, please make your check payable to “St. Mary of Vernon”, write “Mission Trip” and

my name on the memo line, and mail to ST. MARY OF VERNON, ATTN: YOUTH MINISTER,

236 US HIGHWAY 45, INDIAN CREEK, IL 60061. Any donation is greatly appreciated. All

contributions are tax deductible.

As important as the financial aspect is, I will value your prayers even more – not only for me personally,

but for all the participants of the St. Mary of Vernon Mission Trip, and for those we hope to serve.

For more information about Catholic Heart Workcamp, please visit their website at

www.heartworkcamp.com.

Thank you for your prayers and support!

--(Student Signature)--

FRIENDS & FAMILY DONATION REQUEST LETTER

RULES

1) If you receive more than $400.00 in donations, under no

circumstances will these funds be returned to the student or

parent. These funds will go towards the general Mission Trip

account.

2) As stated in the Friends & Family Donation Request Letter, all

donations should be mailed directly to St. Mary of Vernon from

the donor. ST. MARY OF VERNON

ATTN: YOUTH MINISTER

236 US HIGHWAY 45

INDIAN CREEK, IL 60061

3) Regardless of how much money is donated on your behalf, your

$125 deposit will not be refunded.

4) Please do not include these RULES with your LETTER. They

are for your information.

5) If you have any questions, please talk to Jim Welch before

mailing the letter.

2019 Summer Mission Trip

Expenses & Payment Schedule

STUDENT’S MISSION TRIP FEE INCLUDES:

• Student’s CHWC Registration Fee

• Mini-Van Rentals (usually about 4-6 mini-vans)

• Gas and tolls for all the vehicles going to/from Fremont, Nebraska (appx. 10 vehicles)

• Lodging at hotels while traveling to/ from Fremont, NE

• Dinner and breakfast at the hotel while traveling to/from Fremont, NE

• Three meals a day while at CHWC

• All extra snack food and beverages while at CHWC

• Lodging while at CHWC

• St. Mary of Vernon t-shirt

• CHWC t-shirt

• ALL Chaperone expenses throughout the trip (including their CHWC Registration Fee)

STUDENT’S MISSION TRIP FEE DOES NOT INCLUDE:

• “Free Day” Expenses which could be your Entrance Fee to park or to whatever we decide to do. This is still to be determined.

• Lunch, snacks and beverages for the ride to/from Fremont, NE. Once we determine our “Free Day” activity, we will know how many meals you will need to purchase.

• Souvenirs—This could include t-shirts, music CDs, etc.

• Tools to be collected, 1 of each: Paint brush, paint roller cover, drop cloth, roll of masking tape

PERSONAL SAFETY TOOL LIST

Each person is required to bring the following items to CHWC. Please put them in a small

backpack and take them to your worksite. These tools will NOT be collected.

*Small insulated water jug

*Safety goggles *Work gloves

*Mini facemask for scraping/painting

Early registration cost prior to February 2nd is $530.

After February 2nd, the cost goes up to $580.

PAYMENT SCHEDULE

1ST NON-REFUNDABLE Payment* is due ASAP......... ……………………………...$125 SMV Parishioners applications will be processed beginning 12/4/18.

Non-SMV Parishioner applications will be processed beginning 12/18/18.

2ND NON-REFUNDABLE Payment is due March 31, 2019 …………………. …...$150

Last NON-REFUNDABLE Payment is due June 15, 2019 ………………. $255/$305* (*This amount depends on the date of registration, if your parent coordinates a fundraiser, and the number of

fundraisers actually worked. This final payment does not include the Free Day expense.)

**If you end up being unable to attend the Mission Trip but we are able to get a

“replacement” for your spot, we should be able to refund your deposit.

If you are unable to pay the full amount, please talk to Jim Welch.

ST. MARY OF VERNON 2019 Summer Mission Trip APPLICATION CHECK LIST

Please use this check list to verify that your Mission Trip Application is complete prior to turning it in.

TEENS

Student Application- Completely filled out with parent and student signatures.

Catholic Bishop of Chicago… Release of all Claims- Must be signed by a parent and student.

Fundraising Commitment Form- The form must be completely filled out, with the fundraisers ranked 1-7.

Payment Form- The form must be completely filled out with the method of payment clearly marked.

Payment- Payment must be included. $125 non-refundable deposit due prior to February 2, 2019. If the application is submitted after February 2nd, a non-refundable deposit of $325 is due (this includes the second payment and a $50 late registration fee).

CHAPERONES

Chaperone Application- Only submit if an adult (parent) would like to go on the Mission Trip as a chaperone. The Form must be completely filled out and signed.

For the Chaperone, a Catholic Bishop of Chicago… Release of all Claims- Must be signed by the chaperone wanting to go.

Chaperones must turn in a copy of their: 1) Driver’s License 2) Auto Insurance card 3) Health Insurance card

An incomplete Application will not be processed until it has been made complete. If you have any questions, please email Jen Daniels (jdaniels@maryofvernon.org) or

Jim Welch (jwelch@maryofvernon.org)

ST. MARY OF VERNON

2019 Summer Mission Trip STUDENT APPLICATION

The 2019 cost is $530 per student, before February 2, 2019. After February 2nd, the cost goes up to $580.

This form, along with a $125 *non-refundable deposit is due at this time to hold your spot. (*If you end up being unable to attend the Mission Trip but we are able to get a “replacement” for your spot, we

should be able to refund your deposit.)

Your second non-refundable payment of $150 is due before March 31, 2019 and your final non-refundable payment is due before June 15, 2019.

Student Name:______________________________________________________________________ please print all information clearly

Address:___________________________________________________________________________ (street)

City:_________________________________________ State:________ Zip:__________________ Home Phone:____________________________ Student Cell Phone:__________________________ Student Email Address:_______________________________________________________________ Parent/Guardian Name(s):_____________________________________________________________ Mother’s Cell Phone:________________________ Father’s Cell Phone:________________________ Parent Email Address:________________________________________________________________ Birthdate:______________________ Student’s Age on June 22, 2019:____________________ High School:_______________________________________ Grade in Fall of 2019:____________ T-Shirt Size:_______ Current Parish: ________________________________________

*I understand that there will be required fundraising events and pre-trip meetings for all CHWC participants to attend. _______ (Initial Here) **I also understand that I am required to supply baked good to both bake sales even if I am not working a bake sale. _______ (Initial Here)

Student Signature:_________________________________________ Date:________________ Parent Signature:__________________________________________ Date:________________

OVER

CATHOLIC BISHOP OF CHICAGO, A CORPORATION SOLE, AND ST. MARY OF VERNON

RELEASE OF ALL CLAIMS

In consideration for being accepted by ST. Mary of Vernon, I (we) being

21years of age or older, do for myself (ourselves and for and on behalf of my

(our) child-participant (if said child is not 21 years of age or older) do hereby

release, forever discharge and agree to forever hold harmless St. Mary of Vernon,

employees and agents thereof, from any and all liability, claims, demands for

personal injury, sickness, death, as well as property damage and expenses of any

nature whatsoever which may be incurred by the undersigned or the child

participant resulting from said child’s participation in the St. Mary of Vernon

Mission Trip, (including travel between the child’s home and the camp, free day

activities, excursions from the camp and anytime spent at the camp).

Furthermore, I (we) (and on behalf of our child-participant if under the age

of 21 years) hereby assume all risk of said personal injury, sickness, death,

damage and expenses as a result of participation as above set forth.

Further, authorization and permission are hereby given to St. Mary of Vernon

to furnish any necessary transportation, food, lodging for this participant.

The undersigned further agrees to hold harmless and indemnify St. Mary of

Vernon, employees and agents, for any loss claim, liability, damage, including

property damage or injury whatsoever incurred by child-participant as a result of

the negligent, willful or intentional acts of said participant, including

reasonable attorney’s fees and other expenses incurred attendant thereto.

If the participant has not attained the age of 21 years:

I (we) am (are) the parent(s) or legal guardian(s) of this participant, and

hereby grant my (our) permission for him (her) to participate fully in said St.

Mary of Vernon Mission Trip, and hereby give my (our) permission to take said

participant to a doctor or hospital and hereby authorize medical treatment,

including, but not limited to emergency surgery or medical treatment, and assume

the responsibility of all medical bills. I give permission for my child to be

transported in privately owned vehicles or in public transportation and for the

release of medical records to an attending physician in case of illness.

Further, should it be necessary for the participant to return home due to

disciplinary action, for medical reasons or otherwise, I (we) hereby assume all

hotel and transportation costs.

I (we) am aware of no physical, mental or emotional problems, which would

limit participation in the St. Mary of Vernon Mission Trip. I (we) am (are)

fully aware of the nature of the St. Mary of Vernon Mission Trip.

Neither the Catholic Bishop of Chicago, A Corporation Sole, not St. Mary of

Vernon will be liable for loss or damage to property of participants prior to,

during or following the work camp due to theft, fire, accident or any other cause

beyond its control.

MEDIA/PHOTO WAIVER:

I hereby authorize and give my full consent to St. Mary of Vernon to publish

any and all photographs, video or audio in which I/my child will appear in while

attending the St. Mary of Vernon Mission Trip.

X____________________________________ X_____________________________________

Print Teen Participant Name Print Custodial Parent Name

X___________________________Date_____ X___________________________Date______

Teen Participant Signature Custodial Parent Signature

ST. MARY OF VERNON 2019 Summer Mission Trip CHAPERONE APPLICATION

If you would like to be a chaperone/group leader on the 2019 Mission Trip to Fremont, Nebraska from June 22-29, 2019, please complete and return this form to Jim Welch as soon as possible to hold your spot.

Please attach to this form a copy of your Auto Insurance Card, Medical Insurance Card, and Driver’s License.

Chaperones are asked to pay for the cost of their own meals; however, other expenses will be covered by Youth Ministry. Chaperone Name:___________________________________________________________________________

please print all information clearly

Address: __________________________________________________________________________________ (street)

City:_____________________________________________ State:___________ Zip:_______________ Home Phone:__________________ Cell Phone: ____________________ T-Shirt Size:______ Email Address:______________________________________________________________________________

Have you completed the Archdiocese of Chicago…

VIRTUS training? YES NO Federal Background check? YES NO DCFS Background check? YES NO Code of Conduct Form? YES NO

Do you have a Mini Van/Large SUV that you would be willing to drive to the camp with teenage passengers? Please Circle either: YES NO

If yes, please indicate year, make, model.

If yes, please indicate the number of seatbelts your vehicle has, including the driver’s.

*I understand that there will be required pre-trip meetings for all CHWC chaperons/group leaders.

Signed:_________________________________________ Date:________________

OVER

CATHOLIC BISHOP OF CHICAGO, A CORPORATION SOLE, AND ST. MARY OF VERNON

RELEASE OF ALL CLAIMS

In consideration for being accepted by ST. Mary of Vernon, I (we) being

21years of age or older, do for myself (ourselves and for and on behalf of my

(our) child-participant (if said child is not 21 years of age or older) do hereby

release, forever discharge and agree to forever hold harmless St. Mary of Vernon,

employees and agents thereof, from any and all liability, claims, demands for

personal injury, sickness, death, as well as property damage and expenses of any

nature whatsoever which may be incurred by the undersigned or the child

participant resulting from said child’s participation in the St. Mary of Vernon

Mission Trip, (including travel between the child’s home and the camp, free day

activities, excursions from the camp and anytime spent at the camp).

Furthermore, I (we) (and on behalf of our child-participant if under the age

of 21 years) hereby assume all risk of said personal injury, sickness, death,

damage and expenses as a result of participation as above set forth.

Further, authorization and permission are hereby given to St. Mary of Vernon

to furnish any necessary transportation, food, lodging for this participant.

The undersigned further agrees to hold harmless and indemnify St. Mary of

Vernon, employees and agents, for any loss claim, liability, damage, including

property damage or injury whatsoever incurred by child-participant as a result of

the negligent, willful or intentional acts of said participant, including

reasonable attorney’s fees and other expenses incurred attendant thereto.

If the participant has not attained the age of 21 years:

I (we) am (are) the parent(s) or legal guardian(s) of this participant, and

hereby grant my (our) permission for him (her) to participate fully in said St.

Mary of Vernon Mission Trip, and hereby give my (our) permission to take said

participant to a doctor or hospital and hereby authorize medical treatment,

including, but not limited to emergency surgery or medical treatment, and assume

the responsibility of all medical bills. I give permission for my child to be

transported in privately owned vehicles or in public transportation and for the

release of medical records to an attending physician in case of illness.

Further, should it be necessary for the participant to return home due to

disciplinary action, for medical reasons or otherwise, I (we) hereby assume all

hotel and transportation costs.

I (we) am aware of no physical, mental or emotional problems, which would

limit participation in the St. Mary of Vernon Mission Trip. I (we) am (are)

fully aware of the nature of the St. Mary of Vernon Mission Trip.

Neither the Catholic Bishop of Chicago, A Corporation Sole, not St. Mary of

Vernon will be liable for loss or damage to property of participants prior to,

during or following the work camp due to theft, fire, accident or any other cause

beyond its control.

MEDIA/PHOTO WAIVER:

I hereby authorize and give my full consent to St. Mary of Vernon to publish

any and all photographs, video or audio in which I/my child will appear in while

attending the St. Mary of Vernon Mission Trip.

X____________________________________

Print Chaperone Name

X___________________________Date_____

Chaperone Signature

ST. MARY OF VERNON

2019 Summer Mission Trip PAYMENT FORM

Student Name:____________________________________________________________________________

please print all information clearly

Address: ________________________________________________________________________________ (street)

City:_______________________________________________ State:________ Zip:__________________ Parent Cell Phone: ___________________ Student Email Address:_____________________________________________________________________ Parent Email Address:______________________________________________________________________

St. Mary of Vernon must pay the full balance to the Catholic Heart Workcamp by May 1, 2019. If your teen backs out, we lose hundreds of dollars. For this reason, payments cannot be refunded unless someone else fills your teen’s spot.

I understand that the payments are non-refundable after each payment deadline, unless another teen is found to fill my teen’s spot.

Parent’s Signature: _________________________________________ Date: ________________ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Paying by CREDIT CARD:

Please charge my: __Visa __MasterCard __AmEx __Discover

Card #: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name on Card: _________________________________________

Exp. Date: _________ Security Code: ___________ Auth. Signature: ____________________________________________________ Select which payments you would like charged.

__ $125 Non-refundable Deposit charged on date application is received ______________ Date

__ $150 Non-refundable 2nd Payment charged on March 31, 2019

__ Non-refundable Final Payment charged on June 15, 2019 (Final Balances will be available by first part of June)

THERE IS AN ANNUAL ONE-TIME $5 SERVICE FEE ON YOUR FIRST CREDIT CARD PAYMENT ONLY.

FOR OFFICE USE ONLY

Payment # _____ Date Received: ________ Payment # _____ Date Received: ________ Payment # _____ Date Received: ________ CASH CHECK CREDIT Check #: ________ CASH CHECK CREDIT Check #: ________ CASH CHECK CREDIT Check #: ________ Amount: $__________ Amount: $__________ Amount: $__________ Balance: $__________ Balance: $__________ Balance: $__________

Paying by CHECK:

___ Attached is a check in the amount of $__________

Date Received: ___________ Check #: ________

Balance Due: ___________

Paying by CASH:

___ Attached is cash in the amount of $__________

Date Received: ___________

Balance Due: ___________

ST. MARY OF VERNON 2019 Summer Mission Trip

FUNDRAISING COMMITMENT

Student Name:____________________________________________ COMPLETE THE FUNDRAISING SIGNUPS: Please number each of these fundraising opportunities between 1 and 7, with 1 being your first choice and 7 being your last choice (Not counting the Car Wash). We will try our best to accommodate your preferences based on when you submit this form. To receive the maximum $150 discount, you will need to complete 3 fundraising opportunities. You will receive an email letting you know, in advance, which 3 fundraisers you’ve been assigned. If you cannot work at your assigned fundraiser, please find a family member or fellow teen to sub for you. We are counting on you to be there to work your shift. _______ Work at SMV Friday Night Lenten Fish Fry March 8th _______ Work at SMV Friday Night Lenten Fish Fry March 15th _______ Work at SMV Friday Night Lenten Fish Fry April 5th _______ Work at First Bake Sale after Mass weekend of February 16 & 17 Select Mass preference: 5:00pm 7:45am 9:30am 11:15am

_______ Work at Second Bake Sale after Mass weekend of April 27 & 28 Select Mass preference: 5:00pm 7:45am 9:30am 11:15am

_______ Work at First Stock Certificate Sale after Mass weekend of June 1 & 2 Select Mass preference: 5:00pm 7:45am 9:30am 11:15am

_______ Work at Second Stock Certificate Sale after Mass weekend of June 8 & 9 Select Mass preference: 5:00pm 7:45am 9:30am 11:15am _______ Work at Alpha Omega Car Wash during Mass July 14 (raindate July 21)-

EVERYONE IS REQUIRED TO WORK THIS EVENT

Parent Name: ______________________________________________________ If you volunteer, and follow through as a Coordinator for one of these Fundraisers, you will receive a

$50 discount on the Mission Trip cost.

I am willing to Coordinate one of the following fundraisers: Please rank your choices in order of preference.

_______ First Bake Sale, February 16 & 17

_______ Second Bake Sale, April 27 & 28

_______ First Stock Sale, June 1 & 2

_______ Second Stock Sale, June 8 & 9