Happening Participant Registration "*" indicates required fields Happening #80 Participant RegistrationHappening is a Christian experience presented by teenagers, for teenagers with the help of clergy and lay adult leadership. The Happening program is meant to be one of the instruments within the Anglican Tradition of renewing the Christian church in the power of the Holy Spirit, so that the church may more readily respond to its call to spread the Kingdom of God throughout the world. It seeks to achieve this purpose by bringing young persons and adults to fuller personal knowledge of and relationship with the Lord Jesus Christ and to a deeper level of commitment and apostleship. Happening #80 will take place at Grace Episcopal Church in Carthage, MO from September 27-29, 2024.Participant InformationName* First Last Birthdate* MM slash DD slash YYYY Gender Identity* Male Female Non-Binary Other Current Grade (2024-2025 School Year)*9th10th11th12thAdult ParticipantParticipant Email A parent/guardian can enter their email later if participant does not have email access please leave this blank.Participant Mobile PhoneA 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dietary Restrictions* Vegetarian Vegan Gluten Free Other None If you clicked other above please explain Congregation*GuestAll Saints, NevadaAll Saints, West PlainsCalvary, SedaliaChrist Church, BoonvilleChrist Church, LexingtonChrist Church, SpringfieldChrist Church, St. JosephChrist Church, WarrensburgGood Shepherd, KCGrace and Holy Trinity Cathedral, KCGrace Church, CarthageGrace Church, ChillicotheGrace Church, LibertyRedeemer, KCResurrection, Blue SpringsShepherd of the Hills, BransonSt. Alban's, BolivarSt. Andrew's, KCSt. Anne's, Lee's SummitSt. Augustine's, KCSt. George's, CamdentonSt. James, SpringfieldSt. John's, NeoshoSt. John's, SpringfieldSt. Luke's, Excelsior SpringsSt. Mark's, Kimberling CitySt. Mary Magdalene, BeltonSt. Mary's, FayetteSt. Mary's, KCSt. Mary's, SavannahSt. Matthew's, RaytownSt. Matthew's, OzarkSt. Michael's, IndependenceSt. Nicholas', NoelSt. Oswald's, SkidmoreSt. Paul's, ClintonSt. Paul's, KCSt. Paul's, Lee's SummitSt. Peter's, HarrisonvilleSt. Peter and All Saint's, KCSt. Philip's, JoplinSt. Philip's, TrentonSt. Stephen's, MonettSt. Thomas a Becket, CassvilleTransfiguration, Mountain GroveTrinity Church, IndependenceTrinity Church, LebanonParent/Guardian Contact InformationParent/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 #2Health Information & Emergency ContactPlease 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 Select files 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 MedicationsPlease 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 availableDo you anticipate bringing prescription medicine on this trip?* Yes No 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 TreatmentParent/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 LogPlease 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 CovenantThe 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 Liability Release* I have read and agree to the liability release.In consideration of agreeing to attend and participate in the Diocese of West Missouri Happening Retreat I do hereby release, discharge and agree to indemnify the Diocese of West Missouri, its Council of Trustees, officers, ministers, staff, employees and agents and anyone else connected with said organization against any loss, expense or judgment said organization or he/she/they may suffer or incur as a result of any claim or action that may be made or brought by or on my behalf in connection with or arising out of or suffered during my participation in said Happening RetreatLiability Release* I have read and agree to the liability release.In consideration of allowing my/our child to attend and participate in the Diocese of West Missouri Happening Retreat I/we on behalf of myself/ourselves and on behalf of said child do hereby release, discharge and agree to indemnify the Diocese of West Missouri, its Council of Trustees, officers, ministers, staff, employees and agents and anyone else connected with said organization against any loss, expense or judgment said organization or he/she may suffer or incur as a result of any claim or action that may be made or brought by or on behalf of my/our child in connection with or arising out of or suffered during his/her participation in said Happening RetreatParticipant Signature*Parent/ Guardian Signature*PaymentThe cost for the Happening Weekend is $60 Please contact the Youth Missioner at wemoyouth@diowestmo.org if you have any questions. If you would like to make a scholarship request, you can do so here: https://forms.office.com/r/SurySsFnW3Price* Check – $60 Paypal/Credit Card-$60 If paying by check, make check payable to the “Diocese of West Missouri” with the name of the participant the memo line, and mail check to: The Diocese of West Missouri Attn: Youth Missioner 420 W 14th St. Kansas City, MO 64105.Payment Method*PayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total EmailThis field is for validation purposes and should be left unchanged. Δ