September 25-27, 2015 - Our Lady of Hope Catholic Church

The Office of Youth Ministry for the Catholic Diocese of Arlington is sponsoring a pilgrimage to Philadelphia to participate in the World Meeting of Families and the Papal Mass. This pilgrimage is open to all 9th‐12th graders during the 2015‐2016 school year.
September 25‐27, 2015
$200 cost includes:
‐deluxe motor coach transportation
‐accommodations at youth retreat center
‐some meals
‐pilgrimage t‐shirt and credentials
‐access to Papal Mass and other activities
World Meeting of Families with Pope Francis
September 25-27, 2015
Registration and Pilgrimage Information
General Information
The World Meeting of Families (WMOF) is a large international event that happens every three years
someplace around the globe. This time it is being hosted in Philadelphia on September 22-27, 2015. For
more information about this gathering, go to www.worldmeeting2015.org.
At the end of this week-long event, Pope Francis is planning to attend two large gatherings on
September 26, 2015 and celebrate a large outdoor Mass on September 27, 2015. The Arlington Diocese
Office of Youth Ministry is sponsoring a pilgrimage for high-school aged students to attend these events.
Unfortunately none of the details for these gatherings have been finalized yet and we are being told that
they may not be finalized until mid-April. This means we do not know the exact times or costs for
anything happening that weekend. There is also no guarantee that we will even get tickets for the
smaller events.
At a bare minimum we are confident that there will be plenty of opportunities for us to have an
enjoyable pilgrimage to Philadelphia and participate in the large outdoor Mass with the Pope on
September 27th. If we are unable to gain access to other events, we will work with speakers and
musicians to create our own prayer and pilgrimage experiences.
Who can attend
This pilgrimage is for students who are in 9th-12th grade during the 2015-2016 school year. Students can
register up to September 1st as long as there are still spots available. Registration consists of full
payment, a completed conduct covenant and a signed permission slip. Any student who violates the
conduct covenant will have their parents contacted immediately so that they may come and pick up
their child.
Accommodations
All hotels and camps in and around Philadelphia have been reserved by travel agents who are now
charging inflated rates to any groups that want to stay there, and many of them are already filled. This
is why we must begin the registration process now, and cannot wait until all information about the
WMOF is finalized. We were able to reserve accommodations an hour south of Philadelphia at:
Sandy Hill Camp and Retreat Center
3380 Turkey Point Road
North East, MD 21901
www.sandyhillcamp.com
This camp offers large bunkhouse style lodges featuring electricity, air-conditioning, heating, individual
storage cubbies, fans, lights, and modern bathrooms. These lodges will be separated by gender. All
diocesan policies for child protection will be followed.
Transportation
Depending upon the number of pilgrims, there will likely be 4-5 motor coaches (with bathrooms)
departing from different locations throughout the diocese. The plan will be for these buses to all arrive
at the camp at approximately the same time on Friday evening. These same buses will be used
throughout the weekend to take us into and out of Philadelphia for the events.
Schedule
-Buses will depart from various locations around the diocese at approximately 5pm-6pm on Friday (25th)
and arrive at the retreat center by 8pm. There may be a short program that evening.
-Saturday (26th) the buses will take us into Philadelphia to participate in the WMOF activities for the
entire day and bring us back to the camp in the evening.
-Sunday (27th) we will pack everything back into the buses and be driven into Philadelphia for the Papal
Mass. After the Mass we will return by bus to our original departure spot in Virginia. Unfortunately, we
do not know if the Mass will be in the morning or afternoon and therefore do not know what time we
will be returning.
Meals
-Pilgrims should eat dinner before boarding the buses in Virginia. We will have a snack available when
they arrive to the retreat center. The buses are not planning to stop en route to the retreat center.
-The only meals that are being provided in the cost of the trip are the two breakfasts at the retreat
center and nighttime snacks. All other meals will be on-your-own while at the activities in Philadelphia. If
we determine that it makes sense for us to order other meals or provide carry-out meals for the whole
group, then we will work to make this happen and increase the cost of the trip accordingly.
-After the Mass on Sunday, the buses will most likely stop for a meal on the way back to Virginia.
Registration Fee and Payment Schedule
The diocese is not making any money on this pilgrimage and is charging the bare minimum to the
participants. At this point, the total cost per person is $200. This covers bus transportation, retreat
center housing, some meals, and a pilgrimage T-shirt. If we discover that we are required to purchase
tickets for the events on the 26th, or discover that it makes sense for us to provide additional meals as a
part of the trip, then we will have to pass those costs on to the participant.
A deposit of $50 per person along with a completed Stakeholder Covenant is required to reserve a spot
on the pilgrimage. Please submit these deposits as soon as possible so that we can reserve as much of
the retreat center as we think we will need.
The individual registration forms consist of:
1. Code of Conduct (Youth or Adult)
2. Permission Slip (Youth or Adult)
Please submit forms as soon as you have them to guarantee each specific person has a spot. There is the
chance that some of the last pilgrims to register may not be able to use a spot on the pilgrimage
because there are no beds left in the lodge of their gender. Therefore you may need to find a person of
a different gender to use that particular reserved spot.
A second payment of $75 per person is due on May 1st.
The balance of $75 per person is due on September 1st. This is also the last date to submit individual
registration forms. All deposits and payments are non-refundable.
Adult Leaders
This pilgrimage will require a 1:7 adult to youth ratio for each gender. Adult leaders must be at least 21
years old, and in full compliance with the OPCYP requirements. Adult leaders must be registered by
September 1st, although if you wait until the last minute and they are not compliant when we run the
report through OPCYP, then they may not be able to attend (along with 7 of your teens.) Adults must
also abide by the conduct covenant while on the pilgrimage.
What do I need to bring?
-Sleeping bag or bed sheets and blanket for a bunk bed
-pillow
-Towel and toiletries
-Clothes appropriate for being outdoors for long extended periods of time…be prepared for blazing hot
sun for several hours, or cold rain showers for several hours. All clothing must meet the dress code
specified in the conduct covenant.
-Water bottle (that you can afford to lose)
-Spending money for meals and possible souvenirs
-Small bag or backpack to have all day, ready to be inspected at security points, and possibly even left
behind if not permitted into an event.
-Rosary, small items to be blessed by the pope.
What am I not permitted to bring?
-Laptops, tablets, iPads, iPods, or portable gaming systems are not permitted. If they are seen, they will
be confiscated until the end of the pilgrimage.
-Adults and Teens are permitted to bring their cell phones. Teens should only use their phone as a
camera or for emergency use. We are asking adult leaders to enforce this. Even while riding on the bus,
or waiting for the papal mass to begin, we would like teens to be in conversation with others, or spend
time in quiet reflection, rather than listening to music, texting, or playing games on their phones.
-alcohol, illegal drugs, tobacco products
-anything of value that you are not willing to lose
WorldMeetingofFamilies2015
StakeholderCovenant
(duewithinitialparishdepositof$50perpilgrim)
Stakeholder Information:
Name: ____________________________________ Parish: ______________________________
Daytime phone: _____________________________ Cell Phone: _________________________
Email: _____________________________________
Please read the Stakeholder requirements and sign the below covenant:

I will be the single point of contact for my parish youth and adults.

I will oversee the fundraising within the parish, I will insure that the proper adult/student ratio is met (1 to 7),
and that all adult leaders have met the requirements of the Office of Child Protection.

As Stakeholder, I am over 25 years old, and I understand that I am required to attend the pilgrimage for the
entire time.

As a representative of my parish community team, I am registering the following participants for the pilgrimage:
Pilgrimage:
Youth Participants:
Adult Leaders (21+):
Total # of Pilgrims:
__________
__________
__________ x $50 = $___________
{Please attach one parish check made out to the “Catholic Diocese of Arlington”}
In my actions and words, I will strive to proclaim the Gospel and walk in the footsteps of Christ
as a Stakeholder for the World Meeting of Families Pilgrimage 2015.
Prayerfully,
Stakeholder: ___________________________________
Date: _______________________
Pastor (required): _______________________________
Date: _______________________
World Meeting of Families
Pilgrimage 2015
Send parish check
(made payable to “Catholic Diocese of Arlington”) to:
Catholic Diocese of Arlington
Attention: Office of Youth Ministry
P.O. Box 1960
Merrifield, VA 22116-1960
PLEASE MAKE A COPY OF THE FORM BELOW AND MAIL WITH EACH PAYMENT
Using the form below each time your parish makes a payment will minimize any
accounting errors at the Diocese…thank you!
Payment Schedule:
$50 initial deposit
needed to reserve each spot
$75 second payment
due by May 1, 2015
$75 final payment
due by September 1, 2015
All deposits and payments are non-refundable
-----------------------------------------------------------------------------------------------------------------
World Meeting of Families 2015 Payment
Catholic Diocese of Arlington
Attention: Office of Youth Ministry
P.O. Box 1960
Merrifield, VA 22116-1960
AMOUNT ENCLOSED: $___________________
FOR : DEPOSIT / PAYMENT / ADD-ONS (CIRCLE ONE)
STAKEHOLDER: _______________________________________
PARISH: ________________________________________
Misc. Notes: _____________________________________________________
_________________________________________________________________
_________________________________________________________________
World Meeting of Families Youth CONDUCT COVENANT
(copy of this and permission slip to stakeholder, originals to Office of Youth Ministry by September 1st)
I ,_______________________________________, am a participant in the Arlington Diocesan World Meeting of Families pilgrimage to
Philadelphia, Pennsylvania. This covenant is in effect from the moment I step onto the bus in Virginia on September 25th until the moment I return to
my starting place on September 27th.
As a pilgrim of World Meeting of Families, I will be expected to:
 Be aware of and promote individual and group safety at all times.
 Participate fully in all planned activities, group sessions, and programs.
 Stay with my adult leader at all times. Individuals are not permitted to go off on their own.
 Respect facilities at the retreat center. We are guests and need to exercise care and concern in all situations.
Room occupants are responsible for the condition of their room. Damage to the building, furniture or equipment will
be charged to those responsible.
 Observe the lights-out time. Rest is important in order to safely and fully enjoy the World Meeting of Families.
Also, other participants may require more sleep than you. By observing the lights-out rule it will be quiet enough
for everyone to get the sleep they need.
 No visitors from other sleeping rooms are allowed in your sleeping room
 No loud or disruptive behavior
 Respect each other’s privacy. Male and female lodges are carefully marked. No guys will be allowed in the
girls’ lodges and no girls will be allowed in the guys’ area for any reason.
 Leave all gaming systems, tablets, iPods, sports equipment, and other “valuables” at home. Cell phones are permitted
to be used as a camera or for emergency use to contact an adult leader or parent at home. Listening to music, texting,
and playing games are not permitted. This is a pilgrimage for prayer and meeting with people, not isolating oneself.
 Follow the dress code of the pilgrimage. Because you will be participating in Mass and other prayer experiences, the
dress code requires that shorts come down to at most 3” above the knee. Shirts must have a collar (no spaghetti straps or
halter tops). Shoes should be comfortable for long walks. Be prepared for blazing hot sun or cold rain for many hours.
 Refrain from telling/being involved in jokes or pranks about bombs or terrorism. Any participant attempting such
pranks will be held accountable by law enforcement agencies.
 Refrain from smoking during the entire pilgrimage.
 Refrain from alcohol or illegal drugs at any time during the pilgrimage. (All adults are expected to do the same.)
We are requiring that all pilgrims refrain from drinking alcohol while on this pilgrimage. If anyone is found
to be drinking alcohol or using illegal drugs, they will be sent home immediately at their parent’s expense
and any remaining pilgrimage forfeited.
MY PROMISE:
I freely execute this acknowledgement with full knowledge of its content. I promise to live by these guidelines and expectations in my
attitude and my actions. I will also encourage other participants to live with this promise. I understand that if I choose by my attitude
or by my actions to not live up to these expectations, I will face consequences, which may include being sent home immediately at
my own expense. No refunds will be given for any unused portions of the pilgrimage.
Participant signature: _____________________________________________________Date____________________________
As Parent or legal guardian I remain fully responsible for any legal/financial responsibility which may result from any personal
actions taken by the named participant.
Parent/Guardian signature:_________________________________________________Date____________________________
WORLD MEETING OF FAMILIES 2015 YOUTH PERMISSION SLIP
T-SHIRT SIZE:______
As the parent/legal guardian of _______________________________ , permission is hereby given for my child to
attend the Diocesan Pilgrimage to the World Meeting of Families on September 25-27, 2015 in Philadelphia,
Pennsylvania. The meeting time will be at _______________________ (time) and the pickup time will be
____________________ at __________________________________ (location).
I understand and acknowledge that participation in the activities involves inherent risks of injury to my child
including risks associated with transportation by motor vehicle. I agree to indemnify the Parish, Youth Ministers,
Volunteers, and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in the
activities including the cost of any medical care given my child or any expenses or fees incurred in any lawsuit
arising as a result of any damage or injuries caused by my child in the course of his or her participation in the
activity.
I further give my consent that in my absence the above-named minor be admitted to any hospital or medical facility
for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of
Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures,
treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a
guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any
specimen or tissue taken from the above-named minor.
I authorize the Diocese of Arlington to use my child’s picture or video recording for educational and/or marketing
purposes. Parents /guardians who do not wish their child to be photographed or filmed should notify the Office of
Youth Ministry in writing. I understand that in the event my child becomes ill with a communicable illness during
the trip, I have to make immediate arrangements to retrieve my child from the trip location.
Date of Birth
Date of last Tetanus Booster
Known allergies including any allergies to medicine (Continue on back of form if needed)
Any other medical problems which should be noted (Continue on back of form if needed)
Name of Parent/Guardian
Address
Phone Home
City/State/Zip
Work
Mobile
Person responsible for charges (if different from above)
Address
Phone Home
City/State/Zip
Work
Mobile
Work
Mobile
Person to notify if parent/guardian is unavailable
Phone Home
Family Physician Phone
Insurance Carrier & Policy Number
Signature of Parent
Date
Signature of Witness
Date
PERMISO PARA ASISTIR AL ENCUENTRO MUNDIAL DE LAS FAMILIES
TALLA DE CAMISA: ______
Como padre/tutor legal de ____________________________________, autorizo para que mi hijo(a) a participar en la
Peregrinación Diocesana al Encuentro Mundial de las Familias el 25-27 de septiembre, 2015 en Filadelfia, Pensilvania.
Nos reuniremos ese día a las _______________ y favor recoger a su hijo(a) a las _____________________ en
__________________________________.
Yo reconozco y entiendo que la participación en este tipo de actividades conlleva riesgos de lesión para mi hijo(a),
incluyendo aquellos relacionados con el transporte. Yo acuerdo indemnizar a la parroquia, los Youth Ministers,
voluntarios y a la Diócesis de Arlington por cualquier costo o gasto que pudiera surgir debido a la participación de mi
hijo(a) en esta actividad, incluyendo el costo médico de aquello que se le tuviera que administrar a mi hijo(a) o en los
gastos incurridos en cualquier demanda que resultara como consecuencia de daños o lesiones causadas por mi hijo(a)
debido a la participación en esta actividad.
Asimismo, también autorizo a que en mi ausencia, el menor, que arriba se menciona, sea admitido en un hospital o
instalación médica para obtener diagnóstico y tratamiento. Solicito y autorizo a los médicos, dentistas, y personal, con las
debidas licencias de Doctores en Medicina o Doctores de Dentistería, o a otros técnicos y enfermeros licenciados, a que
ejecuten cualquier procedimiento de diagnóstico, tratamiento, procedimiento operativo y tratamiento de rayos-x al menor
arriba mencionado. Entiendo que no se me garantizan los resultados de exámenes o tratamientos. Autorizo al hospital o
instalación médica a que dispongan de cualquier espécimen o tejido que se haya tomado del menor arriba mencionado.
Autorizo a la Diócesis de Arlington para que utilice fotos o video de mi hijo/a por razones educacionales y/o
publicitarias. Los padres o guardianes que no quisieran que su hijo/a fuera fotografiado o filmado, deberán notificar por
escrito a la Oficina para Jóvenes Adolescentes. Entiendo que en el caso que mi hijo/hija estará enfermo durante la
excursión con una enfermedad comunicable, tengo que hacer arreglos para recoger mi hijo/hija desde el sitio de la
excursión.
Fecha de Nacimiento
Fecha de la Ultima vacuna de tétano
Alergias conocidas, incluyendo cualquier alergia a medicinas (Continúe al reverso de la hoja si fuera necesario)
Algún otra condición medica
Nombre del Padre/Tutor Legal
Dirección
Número de Teléfono de la Casa
Ciudad/Estado/Código Postal
Trabajo
Móvil
Persona responsable por los gastos (si es diferente de la que se menciona arriba).
Dirección
Número de Teléfono de la Casa
Ciudad/Estado/Código Postal
Trabajo
Móvil
Persona a quien se pueda recurrir si los padres/tutor no estuvieran disponibles
Número de Teléfono de la Casa
Trabajo
Móvil
Teléfono del Médico de la Familia
Compañía de Seguros y Número de la Póliza
Firma del Padre/Madre/Tutor
Fecha
Firma del Testigo (Encargado del evento o chaperón)
Fecha
World Meeting of Families ADULT LEADER CONDUCT COVENANT
(copy of this and adult release form to stakeholder, originals to Office of Youth Ministry by September 1st)
I, _______________________________________, am an adult leader (21 yrs. and older) on the Arlington Diocesan World Meeting of Families
pilgrimage to Philadelphia, Pennsylvania. This covenant is in effect from the moment I step onto the bus in Virginia on September 25th until the
moment I return to my starting place on September 27th.
As an adult participant in the World Meeting of Families, I will be expected to:
Be a Minister of Christ to all. As a Christian adult, I exemplify through my actions exactly the attitude and behavior
which I expect from young people. I will exhibit an exciting energy and smile!
Participate fully in all planned activities, group sessions and programs.
Watch over all youth participants at all times. Stakeholders / adult leaders need to remain available and ready to serve.
Individuals are not permitted to go off on their own.
Support one another and the youth. As an adult on this pilgrimage you will be interacting with other adults and
youth 24 hours a day. You may be called upon to handle some difficult situations, some of which may require
disciplinary action. If this is the case, please notify the pilgrim’s stakeholder or diocesan staff member immediately.
Be aware and promote individual and group safety at all times. This is extremely important and cannot be stressed
enough. Be sensitive to heat related headaches and dehydration symptoms.
Respect facilities at the simple accommodation site(s). Room occupants are responsible for the condition of their
room. Damage to the building, furniture or equipment will be charged to those responsible.
Observe the lights-out time. Rest is important in order to safely and fully enjoy this pilgrimage. Also, other
pilgrims may require more sleep than you. It is the responsibility of the stakeholder to have all their youth and
adult leaders in their own sleeping rooms at the required time and to enforce the lights out rule.
No visitors from other groups/ family members are allowed in your sleeping room.
No loud disruptive behavior
Respect each other’s privacy. Male and female lodges are carefully marked. No guys will be allowed in the
girls’ lodges and no girls will be allowed in the guys’ area for any reason.
For your protection and the safety of young people, you should never be alone with a minor.
Leave all “valuables” at home. Laptops, iPods and tablets are not permitted. This is a pilgrimage for prayer, meeting
the youth and interacting with them, not isolating oneself.
Follow the dress code of the pilgrimage. Because you will be participating in Mass and other prayer experiences, the
dress code requires that shorts come down to at most 3” above the knee. Shirts must have a collar (no spaghetti straps or
halter tops). Shoes should be comfortable for long walks. Be prepared for blazing hot sun or cold rain for many hours.
Refrain from telling/being involved in jokes or pranks about bombs or terrorism. Any participant attempting such
pranks will be held accountable by law enforcement agencies.
We are requiring that all pilgrims (including adults) refrain from drinking alcohol while on this pilgrimage. Anybody
found to be drinking alcohol or using illegal drugs will be sent home immediately at their own expense and any
remaining pilgrimage forfeited.
MY PROMISE:
I freely execute this Acknowledgement with full knowledge of its content. I promise to live by these guidelines and expectations in my
attitude and my actions. I will also encourage other participants to live with this promise. I understand that if I choose by my attitude
or by my actions to not live up to these expectations, I will face consequences, which may include being asked to return home at my
own expense. No refunds will be given for any unused portion of the pilgrimage.
__________________________________________________________
Signature of Adult Leader
_________________________________
Date
WORLD MEETING OF FAMILIES 2015 ADULT RELEASE FORM
T-SHIRT SIZE:______
I, ___________________________________________ am an adult leader on the Diocesan Pilgrimage to the World
Meeting of Families on September 25-27, 2015 in Philadelphia, Pennsylvania. I hereby acknowledge that this program
may involve a variety of activities which may be both physical and mental in nature. These activities are designed to be
within the limits of a person who is in reasonably good health. The level of participation in all programs and activities is at
all times completely up to the individual. Safety is a high priority in all programs. In addition, each participant must
assume the risk that he or she may suffer an emotional or physical injury and disability.
Liability Coverage: I have been informed that the Diocesan Insurance Program maintains comprehensive general
liability insurance, as well as directors and officers insurance, to protect me as a “Covered Person” for my negligent
actions covered under these policies, only while acting in the scope of my defined responsibilities, which may result in
damage or injury to another person or persons. However, I acknowledge these policies will not protect me for criminal or
intentional acts committed by me. I further understand that there may be no insurance coverage for allegation of
negligence in claims of sexual abuse activity involving a minor, which would include hiring, retention, and/or supervision
of any kind.
Reimbursement of Medical Expenses: I recognize and acknowledge there is volunteer accident coverage as well as
medical payments coverage available to me in order to compensate me for expenses I incur from deductibles, copayments, prescription drugs, or medical services not covered through my own health insurance provider(s) for any injury
I sustain as a result of performing my services. I agree that any medical coverage(s) I have will be primary and under no
circumstance will I seek any contribution from the Parish, or their insurer, for any medical expenses until all underlying
coverage that may or may not apply is exhausted. I acknowledge that the circumstance and levels of coverage may vary
and that the Diocese is under no obligation to continue to maintain any such coverage for my medical expenses.
Informed Consent to Medical Treatment: In the event of an injury, I hereby give the PARISH full authority to take
whatever action they feel is warranted under the circumstances regarding my health and safety if I am not in a condition to
give informed consent including but not limited to the application of emergency medical procedures, the admittance to a
hospital, or the care of a medical professional at my expense.
Safety: Further, I agree to follow all procedures and safety precautions set forth by the Diocese and the PARISH in
addition to ensuring the protection of minors from sexual misconduct and/or child abuse in order to conform with the
requirements adopted by the United States Conference of Catholic Bishops and Catholic Diocese of Arlington Policy on
the Protection of Children/Young People and Prevention of Sexual Misconduct and/or Child Abuse.
Photo: Also, I authorize the Diocese of Arlington to use my picture or video recording for educational and/or marketing
purposes. If you wish not to be photographed or filmed you should notify the Office of Youth Ministry in writing.
I freely execute this Acknowledgement with full knowledge of its content.
Emergency Contact: Name__________________________________
Relationship: _________________________
Phone Number: (H) ___________________ (W) ____________________ (C) ____________________
Health Information: Are there any medical conditions which may affect the participant’s involvement in the above event?
_____________________________________________________________________________________________________
Are there any known allergies including any allergies to medicine? _______________________________________________
_____________________________________________________________________________________________________
Physician and Medical Insurance: Primary Healthcare Provider __________________________
Insurance Company ____________________________________
Phone ________________
Policy Number: ______________________________
_______________________________________________________
______________________________
Signature of Participant
___________________________________________________________
Signature of Witness
Date
______________________________
Date