Steubenville

- Teens

We are going back to the Steubenville Conference this summer!

This is a 3-day weekend event for current high school students (9^th-12^th grade). We will bus down to the Mayo Civic Center in Rochester to join a thousand other teens for this great weekend with fantastic speakers, music, Mass, Adoration, and more! We will be staying in a hotel during the 2 nights as well. This event is a great opportunity to grow deeper in your faith and be equipped to take your next steps with the Lord.
Online Registration for Steubenville 2022
The maximum number of form submissions has been reached. This form is currently not available.
- Event: Steubenville Conference Rochester 2022
  
  Dates: July 15-17, 2022
  
  Who: Current 9th-12th graders ('21-'22 School Year)
  
  Group Leaders: John Boyle, Jonathan Schwartzbauer
  
  Transportation: Bus
  
  Cost of event:
  Regular: $340
  
  Deadline: May 6th
- Household
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- Number of Participants to Register REQUIRED Please fill out this field.
  
  Participant 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Current Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt (Adult sizes) REQUIRED Please fill out this field.
  
  EMERGENCY MEDICAL TREATMENT:
  
  In the event of an emergency, I give permission to transport my child to a hospital. I agree to allow my child to receive emergency medical treatment at my expense at the discretion of the event sponsor. I wish to be advised prior to any further treatment by a doctor or hospital.
  
  In the event of any emergency, if you are unable to contact me at the above numbers, contact:
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  HEALTH INFORMATION:
  Please provide a copy of your Medical Insurance Card)
  
  Medication my child is taking at present: Please enter valid data.
  
  Insurance Company: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Health Plan carrier number: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor: Please enter valid data.
  
  Doctor's Phone Number: Please enter valid data.
  
  I GIVE PERMISSION FOR THE ABOVE NAMES CHILD(REN) TO PARTICIPATE IN THE ABOVE-DESCRIBED EVENT. I warrant that my child is in good health. In consideration of my child’s participation, I agree to indemnify Church of St. Vincent de Paul and the Archdiocese of St. Paul & Minneapolis from any claims or law suits brought by myself, my child, or others, that arises out of any behavior by my child at the event/activity described above. I also agree to pay reasonable attorney’s fees or expenses incurred by Church of St. Vincent de Paul, and the Archdiocese of St. Paul & Minneapolis from in defense of such a claim/suit.
  
  I also hereby waive and release the named church and the Archdiocese of St. Paul/Minneapolis from all claims and liability arising from any acts or omissions by the church, Archdiocese or their agents with regard to any injuries or damages incurred by my child during the ordinary course of the event/activity. This release and waiver shall not apply to claims that may arise from intentional acts.
  
  Should photos or video be taken, I give my permission for the use of the image and/or likeness of my child in any promotional or other marketing activities relating to the event/activity or our parish Youth Ministry without compensation to me or my child.
  
  *If you do not want your child’s image and/or likeness to be used to promote parish youth ministry events, contact the above stated individual in charge to receive a version of this form that does not include the previous clause; however, some events/ activities may require this clause.
  
  SIgned (your name): REQUIRED Please fill out this field. Please enter valid data.
  
  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.)
  
  Medical Treatment: In the event it comes to the attention of the Church of St. Vincent de Paul, other participating parishes, and the Archdiocese of St. Paul & Minneapolis from chaperons 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 at my expense.
  
  Signed (your name): Please enter valid data.
  
  Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are indicated on the Prescription Drug & Medical Authorization Form . (download, fill out and turn in).
  
  Signed (your name): Please enter valid data.
  
  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.
  
  Signed (your name): Please enter valid data.
  
  I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.
  
  Signed (your name): Please enter valid data.
  
  Specific Medical Information: Church of St. Vincent de Paul, and other participating parishes will take reasonable care to see that the following information will be held in confidence.
  
  Allergic Reactions (medications, foods, plants etc.): Please enter valid data.
  
  Date of last tetanus/diphtheria immunization REQUIRED Please fill out this field. Please enter a date.
  
  Does your child have a medically prescribed diet? Please enter valid data.
  
  Any physical limitiations? Please enter valid data.
  
  Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.?
  
  Yes No
  
  If so, date and disease or condition: Please enter valid data.
  
  You should be aware of these special medical conditions of my child:
  
  I have read and agree to the code of conduct
  I Agree Please select this field.
  
  Fee340.0
  
  Participant 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Current Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt (Adult sizes) REQUIRED Please fill out this field.
  
  EMERGENCY MEDICAL TREATMENT:
  
  In the event of an emergency, I give permission to transport my child to a hospital. I agree to allow my child to receive emergency medical treatment at my expense at the discretion of the event sponsor. I wish to be advised prior to any further treatment by a doctor or hospital.
  
  In the event of any emergency, if you are unable to contact me at the above numbers, contact:
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  HEALTH INFORMATION:
  Please provide a copy of your Medical Insurance Card)
  
  Medication my child is taking at present: Please enter valid data.
  
  Insurance Company: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Health Plan carrier number: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor: Please enter valid data.
  
  Doctor's Phone Number: Please enter valid data.
  
  I GIVE PERMISSION FOR THE ABOVE NAMES CHILD(REN) TO PARTICIPATE IN THE ABOVE-DESCRIBED EVENT. I warrant that my child is in good health. In consideration of my child’s participation, I agree to indemnify Church of St. Vincent de Paul and the Archdiocese of St. Paul & Minneapolis from any claims or law suits brought by myself, my child, or others, that arises out of any behavior by my child at the event/activity described above. I also agree to pay reasonable attorney’s fees or expenses incurred by Church of St. Vincent de Paul, and the Archdiocese of St. Paul & Minneapolis from in defense of such a claim/suit.
  
  I also hereby waive and release the named church and the Archdiocese of St. Paul/Minneapolis from all claims and liability arising from any acts or omissions by the church, Archdiocese or their agents with regard to any injuries or damages incurred by my child during the ordinary course of the event/activity. This release and waiver shall not apply to claims that may arise from intentional acts.
  
  Should photos or video be taken, I give my permission for the use of the image and/or likeness of my child in any promotional or other marketing activities relating to the event/activity or our parish Youth Ministry without compensation to me or my child.
  
  *If you do not want your child’s image and/or likeness to be used to promote parish youth ministry events, contact the above stated individual in charge to receive a version of this form that does not include the previous clause; however, some events/ activities may require this clause.
  
  SIgned (your name): REQUIRED Please fill out this field. Please enter valid data.
  
  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.)
  
  Medical Treatment: In the event it comes to the attention of the Church of St. Vincent de Paul, other participating parishes, and the Archdiocese of St. Paul & Minneapolis from chaperons 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 at my expense.
  
  Signed (your name): Please enter valid data.
  
  Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are indicated on the Prescription Drug & Medical Authorization Form . (download, fill out and turn in).
  
  Signed (your name): Please enter valid data.
  
  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.
  
  Signed (your name): Please enter valid data.
  
  I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.
  
  Signed (your name): Please enter valid data.
  
  Specific Medical Information: Church of St. Vincent de Paul, and other participating parishes will take reasonable care to see that the following information will be held in confidence.
  
  Allergic Reactions (medications, foods, plants etc.): Please enter valid data.
  
  Date of last tetanus/diphtheria immunization REQUIRED Please fill out this field. Please enter a date.
  
  Does your child have a medically prescribed diet? Please enter valid data.
  
  Any physical limitiations? Please enter valid data.
  
  Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.?
  
  Yes No
  
  If so, date and disease or condition: Please enter valid data.
  
  You should be aware of these special medical conditions of my child:
  
  I have read and agree to the code of conduct
  I Agree Please select this field.
  
  Fee340.0
  
  Participant 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Current Grade in School REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt (Adult sizes) REQUIRED Please fill out this field.
  
  EMERGENCY MEDICAL TREATMENT:
  
  In the event of an emergency, I give permission to transport my child to a hospital. I agree to allow my child to receive emergency medical treatment at my expense at the discretion of the event sponsor. I wish to be advised prior to any further treatment by a doctor or hospital.
  
  In the event of any emergency, if you are unable to contact me at the above numbers, contact:
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  HEALTH INFORMATION:
  Please provide a copy of your Medical Insurance Card)
  
  Medication my child is taking at present: Please enter valid data.
  
  Insurance Company: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Health Plan carrier number: REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor: Please enter valid data.
  
  Doctor's Phone Number: Please enter valid data.
  
  I GIVE PERMISSION FOR THE ABOVE NAMES CHILD(REN) TO PARTICIPATE IN THE ABOVE-DESCRIBED EVENT. I warrant that my child is in good health. In consideration of my child’s participation, I agree to indemnify Church of St. Vincent de Paul and the Archdiocese of St. Paul & Minneapolis from any claims or law suits brought by myself, my child, or others, that arises out of any behavior by my child at the event/activity described above. I also agree to pay reasonable attorney’s fees or expenses incurred by Church of St. Vincent de Paul, and the Archdiocese of St. Paul & Minneapolis from in defense of such a claim/suit.
  
  I also hereby waive and release the named church and the Archdiocese of St. Paul/Minneapolis from all claims and liability arising from any acts or omissions by the church, Archdiocese or their agents with regard to any injuries or damages incurred by my child during the ordinary course of the event/activity. This release and waiver shall not apply to claims that may arise from intentional acts.
  
  Should photos or video be taken, I give my permission for the use of the image and/or likeness of my child in any promotional or other marketing activities relating to the event/activity or our parish Youth Ministry without compensation to me or my child.
  
  *If you do not want your child’s image and/or likeness to be used to promote parish youth ministry events, contact the above stated individual in charge to receive a version of this form that does not include the previous clause; however, some events/ activities may require this clause.
  
  SIgned (your name): REQUIRED Please fill out this field. Please enter valid data.
  
  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.)
  
  Medical Treatment: In the event it comes to the attention of the Church of St. Vincent de Paul, other participating parishes, and the Archdiocese of St. Paul & Minneapolis from chaperons 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 at my expense.
  
  Signed (your name): Please enter valid data.
  
  Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well-labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are indicated on the Prescription Drug & Medical Authorization Form . (download, fill out and turn in).
  
  Signed (your name): Please enter valid data.
  
  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.
  
  Signed (your name): Please enter valid data.
  
  I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate.
  
  Signed (your name): Please enter valid data.
  
  Specific Medical Information: Church of St. Vincent de Paul, and other participating parishes will take reasonable care to see that the following information will be held in confidence.
  
  Allergic Reactions (medications, foods, plants etc.): Please enter valid data.
  
  Date of last tetanus/diphtheria immunization REQUIRED Please fill out this field. Please enter a date.
  
  Does your child have a medically prescribed diet? Please enter valid data.
  
  Any physical limitiations? Please enter valid data.
  
  Has child recently been exposed to contagious disease or conditions, such as mumps, measles, chickenpox, etc.?
  
  Yes No
  
  If so, date and disease or condition: Please enter valid data.
  
  You should be aware of these special medical conditions of my child:
  
  I have read and agree to the code of conduct
  I Agree Please select this field.
  
  Fee340.0
Total:

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