Diocesan Convention Registration

Diocesan Convention Youth Presence Lock-In Registration

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Diocesan Convention Youth Presence Lock-In

Established in 1890, the Annual Diocesan Convention is the annual business meeting of The Diocese of West Missouri and acts as the primary legislative body of the diocese. It’s a time when clergy and laypeople from all over the diocese come together to vote on an annual budget — called the ‘Plan for Ministry’, to elect officers, and to hear reports of work from diocesan programs. But more importantly, we join together, worship together, learn together, and discern together — reflecting on becoming a better people of God. Attending Diocesan Convention is a great opportunity to see some of the inner workings of the Episcopal Church and meet other youth and adults from around the diocese. There are lots of ways for youth to be involved. There is no cost to attend, but you need to register in advance. The 2024 Diocesan Convention will be held at Grace and Holy Trinity Cathedral in Kansas City on November 8-9. The Youth Presence will include participating in the Convention Eucharist, an overnight lock-in at the Cathedral, a Q&A session with our Bishop Provisional, and more. This year’s convention will culminate in the election of our IX Bishop. The event begins Friday, November 8th at 7pm and ends on Saturday, November 9th at 3pm.

Participant Information

Name*

First Last

Birthdate*

Gender Identity*

Male

Female

Non-Binary

Other

Current Grade (2024-2025 School Year)*

Participant Email

A parent/guardian can enter their email later if participant does not have email access please leave this blank.

Participant Mobile Phone

A parent/guardian can enter their phone number later. If the participant does not have a mobile number please leave this blank.

Address*

Street Address Address Line 2 City State ZIP Code

Dietary Restrictions*

Vegetarian

Vegan

Gluten Free

Other

None

If you clicked other above please explain

Congregation*

Parent/Guardian Contact Information

Parent/Guardian Name #1*

First Last

Parent/Guardian Email #1*

Parent/Guardian Phone #1*

Parent/Guardian Name #2

First Last

Parent/Guardian Email #2

Parent/Guardian Phone #2

Health Information & Emergency Contact

Please provide your health insurance information and up-to-date emergency contact.

Insurance Provider

Name of policy holder

Policy number

Please Upload a photo of the front and back of your insurance card

Drop files here or

Max. file size: 128 MB.

Name of Emergency Contact*

First Last

For Youth this should be someone other than parents

Emergency Contact Mobile Phone Number*

Special Medical Concerns

Please list anything that might limit participation or be important in an emergency.

Recurrent or chronic conditions

Ear Infections

Convulsions/Seizures

Diabetes

Asthma

Nosebleeds

Epilepsy

Other

If none, please leave blank.

If you clicked other above please list it below

Allergies

Penicillin

Poison Ivy

Seasonal/Hayfever

Insect Stings*

Medications*

Food Allergies*

Other

If you clicked an allergy with an asterisk or other please provide details below

Date of last Tetanus Vaccination

Medications

Please provide ORIGINAL prescription bottle with dosage information or smaller “school bottle” provided by pharmacist. All medications must be checked-in with the event nurse, including over-the-counter medications. If you are sending over-the-counter medications, those should be in their original packaging. We will have general medications available

Do you anticipate bringing prescription medicine on this trip?*

Yes

Over the counter medications consent*

Yes, please give my child over the counter medicine if needed.

No, please call me first.

Statement and Consent for treatment*

I have read and agree to the following statement and give my consent for treatment

I agree that I will not attend Diocese of West Missouri youth events if I become exposed to any contagious disease or, if for any reason, I do not consider myself in good physical condition at the time of the event. In the case of accident or illness, I give permission for emergency treatment to be provided by the physician and/or health care facility determined by the persons responsible for the safety and welfare of the participants at the Diocese of West Missouri youth event.

Parent/Guardian Statement and Consent for Treatment

Parent/Guardian Statement And Consent for treatment: I agree that I will not allow my child to attend Diocese of West Missouri youth events if they become exposed to any contagious disease or, if for any reason, I do not consider them in good physical condition at the time of the event. In the case of accident or illness, I give permission for emergency treatment to be provided by the physician and/or health care facility determined by the persons responsible for the safety and welfare of the participants at the Diocese of West Missouri youth event.

Parent/Guardian Signature*

Use your mouse or finger to sign above.

Signature*

Use your mouse or finger to sign above.

Medication Log

Please list the name, dosage, and times of any medications you’re sending on the trip.

Type of Medication

Dosage

Time (AM, Noon, PM)

Type of Medication

Dosage

Time

Type of Medication

Dosage

Time

Type of Medication

Dosage

Time

Type of Medication

Dosage

Time

WEMO Youth Community Covenant

The WEMO Youth Community Covenant is based on Romans 12:10, with an emphasis on respect. We take it very seriously as it is our standard for behavior and our guide to handling any situations that might arise.

“Love one another with brotherly affection. Outdo one another in showing honor.”-Romans 12:10

Participating in Youth Ministry events and activities is a privilege. Participants and adult volunteers are encouraged to enter fully and cooperatively into community life. Standards 1-7 are ideals toward which we strive. Standards 8-12 are non-negotiable and will be enforced on a zero-tolerance basis; if these standards are violated, the violator will be sent home at the expense of the parent/guardian.

1. Respect the other participants and their property

2. Respect whoever is speaking.

3. Respect the adult leaders.

4. Respect the event staff.

5. Respect the people encountered at the event.

6. Respect myself.

7. Agree to remain with the group during activities

8. I agree not to commit acts of theft or violence.

9. I agree not to be involved in bullying

10. I agree not to use or possess any tobacco, alcohol, marijuana or illegal substances.

11. I agree not to bring or use fireworks, firearms, or any other kind of weapons.

12. I accept that sexual behavior is not tolerated, this includes public displays of affection (i.e. holding hands, excessive hugging, kissing, sitting on laps, etc.)

Participants agree that these are reasonable expectations and they will do everything they can to live up to them. If participants choose 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.*

Participant Acknowledgement

As parent and/or 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.

Parent/Guardian Acknowledgement

Photo/Publicity Release Statement: I grant the Diocese of West Missouri permission to record on film, videotape or audiotape my child's (or mine if I am 18) participation in this event. I further agree that any or all of the material may be use, in any form, as part of future production(s) made by the Diocese of West Missouri Program, and further that such use shall be without payment of fees, royalties, special credit, or other compensation.*

I grant my permission

I do not grant my permission

Participant Signature*

Parent/ Guardian Signature*

Phone

This field is for validation purposes and should be left unchanged.