Encounter With God’s Call- Signup

Friday, November 14th to Sunday, November 16th

Vocations Office Staff

Director of Vocations
Fr. Paul J. Clark
573-635-9127, ext. 260

Administrative Assistant
Megan Brondel
573-635-9127, ext. 248

Alphonse J. Schwartze Memorial Catholic Center
2207 West Main St
Jefferson City, MO 65109-0914

Encounter Gods Call Weekend

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Name*

First Last

Preferred Name

Attending as:*

Would you like information on carpooling with the Diocese?*

Yes- I would like information on carpooling with the Diocese

No, I will drive myself to Conception

Year in School*

Birthdate*

Age*

Email Address*

Cell Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Select your parish from our Diocesan List:*

Parent/Guardian Information

Primary Contact: Parent/Guardian Name*

First Last

Primary Contact: Cell Phone*

Primary Contact: Home Phone*

Primary Contact: Email*

Emergency Contact: Name*

Another Parent, Grandparent, Guardian, Relative, etc.

First Last

Emergency Contact: Cell Phone*

Emergency Contact: Home Phone*

Parent Agreement

Read the statements below, checking the box to verify you understand them, and enter your initials in the text area to complete the parent agreement.

Liability Release

I as parent or guardian of my child, do hereby agree to allow my child to participate in the event/activity.

Event: Camp Lolek Session 3 ~ Junior High Boys

Dates: March 28-30, 2025

Location: Conception Seminary (Conception, MO)

Method of Transportation: carpool or parent (to and from Conception Seminary)

I acknowledge that the Diocese of Jefferson City is providing transportation to and from the event/activity and I agree to this. I acknowledge and assume the risk of this transportation for my child.

My child must comply with the Diocesan rules and procedures. In consideration of the Diocese allowing my child to participate in the event/activity, I also waive any claims against, and RELEASE AND HOLD HARMLESS AND INDEMNIFY, the Diocese of Jefferson City, the Parish, and any of its and/or their religious, employees, volunteers, agents and representatives from any liability, claims, demands and causes of action and claims arising out of or relating to any loss, damage or injury sustained in connection with or arising out of my child’s participation in the event/activity, including transporting my child to and from the event/activity.

Liability Release*

I have read the statement above and understand it.

Verify by typing your initials here:*

Video/Photography Consent

I understand and consent that photographs/video recordings/audio recordings of my child may be taken, produced and may be used in publications, websites or other materials produced from time to time by the Office of Youth and Young Adult Ministry, the Diocese of Jefferson City and parishes of the Diocese of Jefferson City (collectively “Diocese”). I also understand that my child will not be identified, without specific written consent. In consideration of the Parish allowing my child to participate in the event/activity, I grant to the Diocese the right to publish, reproduce and display photographic images/video recordings/audio recordings of my child for use in all media, electronic or otherwise, in connection with publications, web pages and/or social media of the Diocese. I hereby authorize the reproduction, sale, lease, copyright, exhibition, broadcast and/or any distribution of said photographs/video recordings/audio recordings without limitation for any purpose whatsoever; and I further waive all rights to any compensation for my child's appearance or participation in the photographs/video recordings/audio recordings. I hereby expressly assign to the Diocese, all the rights, title and interest in, and to all photographs/video recordings/audio recordings made by such in which my child appears and/or his/her voice is used in and in connection with the video recording of this event. I understand and acknowledge that the Diocese has no control over the use of photographs/video recordings/audio recordings taken by media that may be covering the event in which my child participates.

Do you consent to the statement above?*

Yes

Verify by typing your initials here:*

Participant Agreement

Read the statements below, checking the box to verify you understand them, and enter your initials in the text area to complete the agreement.

Youth Participant

In signing the line below, I agree to abide by any/all policies established for this event/activity. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the event and being sent home at mine and/or my parent/guardian’s expense.

Youth Participant*

I have read the statement above and understand it.

Verify by typing your initials here:*

Roman Catholic Values

Camp Lolek is a Roman Catholic Camp and the moral code is based off those teachings. We wish to instill the virtues in each participant. We expect you to be honest, patient, and willing to engage even when you wonder if you can. The staff is here to help you be the best version of yourself you can be.

Roman Catholic Values*

I have read the statement above and understand it.

Verify by typing your initials here:*

No Weapons, Drugs, Alcohol, or other Illegal Items

The Diocese of Jefferson is about providing a safe Catholic environment. The following items are contraband: all firearms, tobacco products, alcohol, and narcotics. Any camper found with these items will be immediately sent home or, if appropriate, handed over to local law enforcement. There is zero tolerance for use of these.

No Weapons, Drugs, Alcohol, or other Illegal Items*

I have read the statement above and understand it.

Verify by typing your initials here:*

Participant Signature*

By typing your full name you are verifying that you have personally read and agreed to this registration. Your full name will serve as your e-signature.

Participant/Parent Signature (if participant is minor, parnent or guardian signature needed)*

By typing your full name you are verifying that you have personally read and agreed to this registration. Your full name will serve as your e-signature.