Summer Service Registration Saint Anne Youth Ministry High School Summer Mission Trip June 24 – June 30, 2018 Registration Deadline is March 19, 2018 Name* First Last Gender*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Student Cell Phone*Student E-mail* School*Current Grade*Birthdate* Are you a member of St. Anne?*YesNoIf not, what church do you belong to?*Guardian 1 Relation*Guardian 1's Name* First Last Guardian 1's Cell Phone*Guardian 1's Email* Guardian 2 Relation*Guardian 2's Name* First Last Guardian 2's Cell Phone*Guardian 2's Email* Return this form, along with the items listed below to St. Anne Youth Ministry, 120 North Ela Street, Barrington, IL 60010 Your registration will not be accepted for this trip until ALL of the below items are received by the Youth Ministry office. Completed registrations will be recorded by the date that all items are received. Registration deadline is March 19, 2018. Parent Permission Form Copy of insurance card (front and back) Participant Agreement Written answers to the following questions – Please explain in about 100 words, why you are applying to take part in this summer service trip. This is a 12 hour van trip to the work site and the living conditions are rustic. What are some of your concerns regarding participating in a trip like this? Payment of $500.00 made out to Saint Anne Catholic Community No refunds within 2 weeks of departure. Registrations will be taken in the order that they are COMPLETED with preferences given as follows: Current seniors who have never participated in a Saint Anne mission trip Current juniors who have never participated in a Saint Anne mission trip Current sophomores and Current seniors / juniors who have participated in past mission trips Non parishioners will be accepted if room permits. Please note that current college aged students are not permitted on this trip. Mission Trip participants are required to participate in two team building activities prior to departure. Please make sure you are available for the dates below and mark your calendars. Tuesday April 24 – 7:00 to 9:00PM Meet and Greet - Parents and students are required to attend Tuesday June 12 – 7:00 to 9:00PM Appalachian movie night and sensitivity training– Students are required to attend Questions? Please contact Michael Hugo at 847.620.3073 or at firstname.lastname@example.org or Karen Poglitsch at 847-620-3072 or email@example.com CommentsThis field is for validation purposes and should be left unchanged.