8th Grade &amp; High School Mission Trip Registration Form 2025

If you will be 18 years old or over by July 13, 2025, please fill out the Adult Registration Form. If not, complete this form.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Age as of July 13, 2025 REQUIRED Please fill out this field. Please enter valid data.

Birthday (Month/Day/Year) REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Teen Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Teen Email REQUIRED Please fill out this field. Please enter an email address.

Best Contact Phone Number for Parent REQUIRED Please fill out this field. Please enter a phone number.

Parent Email REQUIRED Please fill out this field. Please enter an email address.

Participant's Address REQUIRED Please fill out this field. Please enter valid data.

Address 2 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.

Current Grade (as of 2024-25 school year) REQUIRED Please fill out this field.

T-shirt Size (adult unisex) REQUIRED Please fill out this field.

Are you a member of Resurrection Parish? REQUIRED Please fill out this field.

How many times have you attended the summer Mission Trip with Resurrection Parish (formerly St. Thomas More)? REQUIRED Please fill out this field. Please enter valid data.

Are you interested in assisting with daily Mass? REQUIRED No Eucharistic Minister Lector Altar Server Coordinator Please fill out this field.

Are you interested in assisting with music? If so, which instrument? REQUIRED Please fill out this field. Please enter valid data.

Agreements REQUIRED It is expected that ALL teens will attend and actively participate in the mission work for the duration of the trip. It is expected that ALL teens will participate in at least two of the various fundraising activities scheduled throughout the year. I have reviewed the Dates and Deadlines section of this website and I am able to attend all meetings. By signing this form, I agree that I will complete any additional forms, comply with all parish program policies, attend mandatory meetings, and fulfill my assigned work tasks on the trip. I understand that if I am unable to meet these requirements, I will be unable to participate in the mission trip. Please fill out this field.

Code of Conduct REQUIRED The consumption or possession of alcoholic beverages, cigarettes, any tobacco products, or illegal drugs is prohibited. The consumption or possession of any prescription drugs that have not been disclosed on the medical release section below is prohibited. Respect of property, tools, homeowners, adult leaders, participants, and staff of Villa Maria Education and Spirituality Center is expected of all participants. Respect of property, tools, homeowners, adult leaders, participants, and staff of Villa Maria Retreat Center is expected of all participants. Disrespect or mistreatment of other participants is not permissible. Additionally, participants are not permitted to exhibit public or private displays of romantic affection deemed inappropriate by adult leaders. Please fill out this field.

Cost Expectations REQUIRED I understand the cost per person of this trip is $650, less my $50 deposit securing my spot payable online or via check made out to Resurrection Parish. I understand that I must fundraise or pay the remaining balance by 7/01/2025. I understand opportunities will be made available for fundraising throughout the year and a potential fund contribution up to $200 based on a $1 for $1 match on every dollar I raise towards my trip cost. Please fill out this field.

I understand the above expectations and consequences as they have been set forth by the staff of Resurrection Parish. I will obey these rules and any others made before and/or during the trip.

Student Signature REQUIRED Please fill out this field. Please enter valid data.

I understand the above expectations and consequences for my child as have been set forth by the staff of Resurrection Parish. I understand that if my child does not comply, they will incur the aforementioned consequences. I agree to all of the above, and if my child should be dismissed from the trip, I will make arrangements to pick them up within 12 hours.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter a date.

Photo Release REQUIRED

I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.

The Resurrection Youth Mission Trip Ministry DOES have my permission to use my/my child's photograph publicly to promote the Resurrection Youth Mission Trip. Please fill out this field.

In the event of any injury or illness to my/our child during his/her participation in this event, I/we hereby give my/our permission for the necessary medical treatment to my/our child. I/We agree that in case of injury to my/our child, I/we will not look to Resurrection Parish or the Roman Catholic Diocese of Pittsburgh for the payment of any medical costs or injury-related costs.

I Agree Please select this field.

I/We, the parents/guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the Mission Trip on July 13-18, 2025.

I Agree Please select this field.

Liability Release: In consideration for being accepted by Resurrection Parish for participation in this event, I/we, being 21 years of age or older, do for myself/ourselves (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless Resurrection Catholic Parish and the Diocese of Pittsburgh, thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child-participant while said child is participating in the above described event.
Furthermore, I/we (and on behalf of my child participant if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.
Further, authorization and permission is hereby given to Resurrection Parish to furnish any necessary transportation, food and lodging for this participant.
The undersigned further hereby agree to hold harmless and indemnify Resurrection Parish and its employees and agents for any liability sustained as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant there to. (If the participant has not attained the age of 21 years)

I/we 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 event, and hereby give my/our permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and will assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I/we hereby assume all transportation costs.

I Agree Please select this field.

Date of Last Tetanus Shot (Year) REQUIRED Please fill out this field. Please enter valid data.

Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Policy Number REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Treatment Release I/We the undersigned parents/guardians of the abovenamed child hereby authorize treatment of my/our child by a licensed medical professional in case of any accident, illness or emergency that may so arise, or any hospitalization necessary. 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, check ONLY those boxes in accordance with your wishes: My child is taking medication at present. My child will bring all such medication necessary, and such medication will be well-labeled. My child will administer his/her own medication. I hereby grant permission for non-prescription medications (such as Tylenol, throat lozenges, cough syrup, etc) to be given to my child, if deemed advisable. 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.

Disclosure of Prescription Drugs

Any known allergies?

Any physical limitations or work restrictions?

Any medically prescribed dietary needs?

Participant Signature REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Signature REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter valid data.

Trip Deposit50.0

Resurrection Parish

St. John Capistran &
St. Thomas More Churches

8th Grade & High School Mission Trip Registration Form 2025