Western North Carolina - Youth Mission

Registration Options

Youth Participant ($450.00)
Must have completed 6th through 12th grade in the spring of 2025.

Scholarship or Coupon Code

$100 Deposit is NON-Refundable. The remaining balance of $350 will be billed to the card on file on June 15th. The remaining $350 will be NON-refundable June 30th and beyond.

About The Attendee

Please answer the following questions. When permitted, please do not answer, "On File" or "Already Answered" as this will put your application in an incomplete status.

Attendee First and Last Name

Name You Go By

Attendee Email (The one you regularly check!)

Primary Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Attendee Address

Attendee Gender

Pronoun Preference:

Attendee Date of Birth

Current Grade (2024-2025)

Attendee's Parish Name

Attendee's Parish City

Attendee's Youth Leader/Priest/Warden Name

Attendee's Youth Leader/Priest/Warden Email Address

Attendee's Youth Leader/Priest/Warden Phone Number

Attendee's T-Shirt Size

Why do you want to be part of a mission experience serving others through disaster recovery?

What gifts, talents, or skills would you bring to the group and this experience?

Date of Attendee's last Tetanus shot/booster

Please share any dietary, mobility, etc.

Other information about attendee that would be helpful for us to know

Admin Use Only

SKILLS ASSESSMENT

Not everyone has the same level of experience or much experience in some of these areas at all. THAT'S OK! Please answer these questions to the best of your ability.

Outdoor painting like a building

Indoor painting like a wall or room

Using a hammer

Washing windows

Cleaning (kitchen, bathroom, or similar)

Pulling weeds, raking or other light yard work

Trimming hedges using manual trimmers

Mowing a lawn with a push mower

Using a shovel or wheelbarrow

Using tools like pliers, screwdrivers or wrenches

Using a tape measure

Using an electric drill

Using power tools like a circular or jigsaw

Carrying heavy items

I have other skills that might be helpful, not listed above. Please list those here:

ATTENDEE'S COMMUNITY CONVENANT AGREEMENT

Please read the following and sign by using your mouse or finger (depending on your device). We also recommend that you download and print a copy for future reference.

Attendee's Signature Required (Youth)

I, the undersigned, agree to the terms above.

Attendee Medical Insurance Information

Parents/Guardians are financially responsible for all costs incurred, regardless of whether medical insurance coverage information is provided. All medical forms are shredded following each youth event.

Name of Insured

Insured Relation to Attendee

Insurance Carrier

Policy Number

Authorization Phone Number

Prescription Card Information

Please upload a copy of your insurance card if. you are providing this information.

Browse

PHOTO/MEDIA RELEASE

The Diocese takes photographs at all events. As a result you or your young person may be photographed and appear in Diocesan publications, Social Media, or on the Diocesan website for publicity purposes. Some photographs may be identified by name. Please choose “Yes” if you are giving the Diocese permission to publish a photograph of you or your young person. Please choose “No” if you do not want you or your young person’s photograph published.

PARENT/GUARDIAN INFORMATION

1. Parent/Guardian First and Last Name

Relationship To Participant

Primary Phone Number

Secondary Phone Number

Regularly Checked Email Address

2. Parent/Guardian Information

Relationship to the Young Person

Primary Phone Number

Secondary Phone Number

Regularly Checked Email Address

EMERGENCY CONTACT INFORMATION

Please include the name and contact information for an Emergency Contact for your young person WHO IS NOT A PARENT OR GUARDIAN. This should be someone who can be reached in case the PARENT OR GUARDIAN cannot be reached.

Emergency Contact Information

Relationship to the Young Person

Primary Phone Number

Secondary Phone Number

Regularly Checked Email Address

A signed waiver* by the attendee's parent/guardian will be required before you can download your QR code which indicates your registration is confirmed. A link to obtain waivers for all registrants will be shown on the confirmation page you will receive by email.

*as well as check payments

Running Total

$0.00

Total

$0.00

REGISTRATION OPTIONS

About The Attendee

SKILLS ASSESSMENT

ATTENDEE'S COMMUNITY CONVENANT AGREEMENT

Attendee Medical Insurance Information

PHOTO/MEDIA RELEASE

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

BILLING INFORMATION