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The Episcopal Diocese of Maryland Youth & Young Adult Program

Name (and Nickname if applicable)*

Date of Birth & Current Grade Year*

Gender Identity/Pronouns*

I am registering as:*

Youth Participant Adult Volunteer

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Participant Phone*

Participant Email*

Emergency Contact Name*

Emergency Contact Phone Number*

Name of Parish [If applicable]

Include location

Student Requires Service Hours Signature

Yes, please. Send by email or bring to event. No, thank you.

What is your favorite pizza topping?*

Community Expectations & Covenant

In order to live out our individual mission statements for the Youth/Young Adult Ministries and The Sutton Scholar High School Enrichment program, all participants agree to actively participate in all parts of the event and to abide by the standards as set forth below:

1. I will seek to build up myself, others, and our community in my actions and words, doing my best to treat everyone as I want to be treated.

2. I will respect the people, feelings and beliefs of each member of our community.

3. When conflicts happen, I will work to resolve any issues or problems directly with the person or people involved. I will seek assistance as needed.

4. I will engage in our ZOOM activity dressed appropriately at all times. I understand that I must not be laying in a bed, but seated on a chair, floor, couch or other appropriate seating.

5. When participating in our ZOOM Pajama Party, I will ensure that my sleepwear is appropriate to be seen on camera by others. If I do not have pajama’s or sleepwear that appropriately covers my body, I will wear a bathrobe or other appropriate clothing.

6. I will follow appropriate ZOOM behavior and etiquette at all times.

7. I will inform one of the adult leaders if I am having any problems or difficulties participating on-line.

8. I will do my best to have fun!

Adults participating in this event also agree to abide by these standards and assist with supervision of activities on ZOOM. You may be asked to supervise “break-out” rooms at various points of our activities and will ensure that the youth are engaging appropriately at all times.

Adult Acknowledgement of Community Covenant*

As legal guardian of this child I have read the above and believe that he/she is capable of aspiring to and following these community expectations and rules. I also understand that if my child fails to meet these expectations, I will be contacted and asked to bring my child home from the event. As a volunteer adult I have read the above and believe that I am capable of following these community expectations and rules. I understand that if I fail to mee these expectations, I will be asked to leave the event at my own cost. I am aware that the Standards of Behavior for Child-& Youth-Related Programs is available for me to review at www.youth.episcopalmaryland.org

Participant Acknowledgement of Community Covenant*

Participant agrees that these are reasonable expectations and they will do everything they can to live up to them. If participant chooses to violate the rules set for the event, they understand that there will be consequences, which may include parents being notified and being sent home.

Photo/Publicity Release Statement*

I give permission for photographs, video and/or audio recordings of my child or myself to be taken during my child’s or my participation in this event, to be used by the Episcopal Diocese of Maryland and/or The Sutton Scholars High School Enrichment Program for promotional purposes. I do not give my permission.

Waiver of Liability: I release the Episcopal Diocese of Maryland, the Sutton Scholars High School Enrichment Program and its agents, employees, officers, directors and volunteers, from any liability of any kind or nature that may arise in any way from my student’s/my personal participation in this event.*

I have read and agree to the Waiver of Liability.

Participant Signature*

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Guardian Signature

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Consent Form