Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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I agree to the following: I will be dedicated to building a community with my fellow peers. I will abide by the covenant and rules of conduct for the Episcopal Diocese of Iowa and specific to the weekend including: NO leaving the church grounds, unless it is part of the event. I will participate fully in large and small group activities; bring sleeping accessories; change of clothing, and other personal care items. *

Yes

No

We expect each student and adult to conform to this covenant and rules of conduct: With God's help: - I will have an open mind and a positive attitude at this event. - I will participate in all scheduled activities. - I will not leave the event grounds without the permission of an adult chaperone. - I will follow posted rules at any recreation facility and use a seatbelt when in a vehicle. - I agree to follow all rules regarding electronic devices given at each event. - I will respect the dignity of every human being and the authority of adult chaperones. - I will respect church and individual property, and be held financially responsible for willful destruction of any property. - I will visit another's sleeping area only when invited. - I will not participate in sexual behavior. - I will not participate in violent behavior. - I will not possess or use illegal drugs, alcohol, or tobacco, and will not possess or use fireworks, knives, or other weapons. I understand that the above behaviors are non-negotiable and the consequences will include one or more of the following: 1) my parents will be notified, 2) I will be removed from the group's activities, 3) I will be sent home at my family's expense. I understand that the covenant and rules of conduct are designed to make the Youth Event the best and safest event possible for everyone and that if I violate any part of this covenant the adults in charge will have the authority to determine appropriate consequences. I have read the above covenant and rules of conduct and agree to live by these standards throughout the Youth Event. I make this covenant with my sisters and brothers in Christ and I agree to abide by the above guidelines and Consequences. May God who has given us the freedom to choose, give us the strength and guidance to make decisions for the welfare of the whole community. Amen * I agree to abide by the community covenant, stated above. *

Yes

No

I agree to abide by the COVID-19 guidelines for youth events listed on the Episcopal Diocese of Iowa website. *

Yes

No

I acknowledge that my parent/guardian is aware of my plan to attend this event and will support me in attending. *

Yes

No

I acknowledge that clergy at my church is aware of my plan to attend this event and will support me in attending.

Yes

No