St. Herman's West 2017 Registration Form

* Indicates Response Required
Sex *
Do you attend? *

Parish Information

Roommate Preference

Conference participants will be staying at the Homewood Suites Seattle Convention Center Hotel. Rooms will accommodate 4 people. Room occupancy will be assigned into groups of college age and high school age participants. Please list your preferred roommates as per your group category. We will try to honor all roommate requests.

Transportation Information

Do you require transportation to and from the airport? *
All flights must be to and from Seattle International Airport. All participants from Canada must have passports.
Arrival
Departure
Are you traveling in a group?

Church Involvement

Do you sing in your parish choir? *
Do you read at church services? *
Do you serve as an altar boy/acolite in your parish?

Required Health Form

Parent/Guardian information
Emergency Contact (if parent/guardian cannot be reached)
Health Insurance Information
Health History
Does your child suffer or has your child suffered from any of the following: *
 YesNo
Asthma
Diabetes
Seizures
Ear Infections
Food Alergy (list below)
Drug Allergy (list below)
0/255 characters
0/255 characters
0/255 characters

Should my child(ren) require minor medical treatment (for headache, scrapes, coughs, burns, etc.), I give permission to the nursing staff to administer over-the-counter medicine and/or herbal products. 

HOLD HARMLESS AGREEMENT AND MEDICAL RELEASE-Required form for minors

We, the undersigned parent, parents, guardian, guardians are desirous of having our child or children participate at the St. Herman's West Youth Conference and whereas the St. Herman's West Youth Conference is willing to accept them as participants on the condition of this instrument.

 

Therefore, in consideration of the St. Herman's West Youth Conference's authorization, the undersigned parents or guardians and children agree that the children participating in St. Herman's Youth Conference do so at their own risk. Neither the St. Herman's West Youth Conference, Conference Administrators, any volunteer, the Russian Orthodox Church Abroad, St. Nicholas Cathedral, or associate shall be liable for any damages arising from personal injuries sustained by the child in participation of any activity or aspect of the conference. The parents or guardians and child assume full responsibility for any injuries which may occur to the child in said participation and they do hereby fully and forever release and discharge and agree to indemnify and hold forever harmless the St. Herman's West Youth Conference, Conference Administrators, officers, volunteers, the Russian Orthodox Church Abroad, St. Nicholas Cathedral, and associates, individually and jointly, and all employees and agents of them from any and all claims, demands, damages, rights of action or causes of action present or future including claims for contribution and indemnification whether the same be known anticipated or unanticipated resulting from or arising from the above mentioned activity. The undersigned do acknowledge that they have made inquiry into the nature of the activity and have no further questions concerning the nature or conduct of the activity and with such full understanding do hereby cause this instrument of release indemnity to be executed.

 

In the event my child should become ill, or sustain(s) an injury while in the care of St. Herman's West Youth Conference, I, the undersigned parent or guardian, grant authority to the Conference Administrator, nurse, or official to act on my behalf in obtaining any medical treatment that may be necessary. This consent is in effect from December 26, 2017 through December 30, 2017. I will be responsible for all medical expenses. 

Code of Conduct

As a participant of the St. Herman's West Youth Conference, I realize that I represent the Conference and the Russian Orthodox Church in all activities held at the Homewood Suites Hilton, St. Nicholas Cathedral, on the vehicles provided for transportation, Restaurants, and anywhere else the Conference may take the participants. My personal behavior will reflect the way people perceive the Russian Orthodox Church as a whole. I therefore will:

1.          Attend ALL scheduled conference lectures, discussions, church services and activities;

2.          Respect all clergy, conference coordinators, and conference volunteers;

3.          Treat all that I come into contact, with respect and love;

4.          Dress appropriately for all activities; Females: must wear skirts or dresses to all conference lectures; no spaghetti strap shirts; open midriffs, no short skirts or dresses (pants acceptable at outdoor activities); Males: Shirts and pants must be in good condition - no rips, tears, stains, etc. (jeans are acceptable) T-Shirts that are worn must be conducive to a church environment. (No designs/print of bands ...etc.)

5.          Attire for Church Services: Females: modest skirts/dresses and head coverings; Males: long pants/slacks and collared shirts;

6.          Listen to music appropriate to a Church sponsored event and use appropriate language at all times;

7.          I will abide by the curfew set by the St. Herman's Youth Committee and respect the quiet time (11:pm to 8:am) set forth by Homewood Suites, Hilton.

8.          I will abide by all rules and regulations set forth by the St. Herman's Youth Committee, St. Nicholas Cathedral, and Homewood Suites, Hilton.

9.          I will only use transportation provided by St Herman's Conference West. (Exceptions may be made with permission only from Archpriest Boris Henderson).

 

I realize that there are certain things that will not be tolerated at the St. Herman's West Youth Conference and I promise not to partake in any of the following activities:

 

10.        I will not acquire, distribute or consume alcoholic beverages.

11.        I will not acquire, distribute or consume narcotics of any kind or any illegal drugs.

12.        I will not verbally, physically or emotionally assault/abuse others

13.        I will not engage in public displays of affection, and will act appropriately at ALL times.

 

The members of St. Herman's West Executive Committee reserve the right to inspect any facilities where conference attendees reside and any of their personal belongings for the safety and well being of all conference participants.

Any criminal actions will be brought to the attention of the local Authorities.

As a participant at St. Herman's West Youth Conference, I promise to abide by this Code of Conduct. 

As a parent of a minor child attending the Conference, I am aware of, and agree to the Code of Conduct as stated above and whatever disciplinary action is decided upon by the Executive Committee of St. Herman's West Youth Conference, will be abided by. If my child is expelled from the Conference, I agree to pay any transportation costs associated with him/her being transported home.

Payment Information


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