Midwest Mariapolis 2018

Step I: Registration

DIRECTIONS FOR FAMILIES/GROUPS

Fill out the form ONE TIME FOR EACH PERSON in your family/group.
For example, a family of 4 will fill out the form 4 times.
Husbands and wives BOTH need to fill out the form.

This form also includes the parental permission forms.

Parents: Before starting this form, please have on hand the child's physician info (address and phone) and health insurance info (Policy & Group Number).

I am registering *

one person

a member of a family/group

Children 17 and younger ATTENDING AS GUESTS of another family

If you are the parent of the child: To complete this form, you will need the name and emergency contact of the adult responsible for your child during the Mariapolis, as well as your chlid's physician info and health insurance info.
If you are filling out this form but are NOT the parent of the child: You will need to enter the PARENT's name and PARENT's emergency contact into this form. You will also need to inform the parents that they need to fill out a separate online parental permission form. Copy this link and send to parents to complete: https://fs28.formsite.com/focolare/consent/index.html

Primary Contact Email

We will use this email to contact you about updates and other Mariapolis information.

Primary Contact Email *

Re-enter email *

CREATE A GROUP NAME. YOU WILL USE THIS GROUP NAME WHEN FILLING OUT THE FORM AGAIN FOR OTHERS IN YOUR GROUP.

This will link your group together in the Focolare records.

Enter your Group Name *

Mariapolis 2017

Attendee Information

Salutation *

Attendee's First Name *

Attendee's Last Name *

Gender *

Male

Female

Age Group *

Adult

Young Adult

17 and younger

Young Adult - Your Age *

If you are married & your spouse is attending, please provide his/her full name:

IMPORTANT NOTE: Be sure to FILL OUT THIS FORM SEPARATELY FOR YOUR SPOUSE TOO.

Age at the beginning of the Mariapolis - Please enter a WHOLE NUMBER, 0 to 17 *

Exactly how old? Enter how many months. *

Days attending (check all that apply) *

Approximate time arriving

Approximate time departing

Is this the first time attending a Mariapolis? *

Yes	No
It's been a long time since I've last attended

Volunteer

Volunteering could be anything from helping with the nursery to leading a hike or other vacation activity during the Mariapolis. If you have something you are interested in, please enter your interest/ideas below. -- for adults only

Volunteer

Mariapolis 2017

Parent/Guardian Information

Participants under 18 years of age must be accompanied by a parent or an adult.

Will a PARENT be at the Mariapolis the entire time the child is attending? *

Yes

No

I am the parent filling out this form. *

Yes

No

Days a parent will NOT be attending *

Adult who is responsible for the child when the parent is not at the Mariapolis *

Relationship to child *

Responsible adult's phone number while at the Mariapolis in case of an emergency *

Mariapolis 2017

Parental Consent Forms for Minors

Lindenwood NOTE:
The following info is used to fill in the parent permission forms, if a parent is filling out the registration.

PARENTAL PERMISSION FORM - Send this to the parent

In addition to filling out this form for the child who is your guest, you also need to inform the parents that they need to fill out a separate online parental permission form. This is required.

Click here for a link to that form that you can send to the parent.

Alternately, direct the parent to the registration page on the MidwestMariapolis.org website. In step one, have them click on 'Iinformation for parents of children 17 and younger". In #3 of that area, there is a link to the permission slips only form.

TRAVEL CONSENT

My son/daughter listed below has permission to travel with and in the care of the person as stated below for the purpose of attending the Mariapolis Convention of the Focolare Movement to be held at Green Lake Conference Center, Green Lake, WI, from Friday, June 29 trough Tuesday, July 3, 2018. I/We understand that riders in the cars will be required to wear seatbelts.

PARENTAL PERMISSION

I release and discarge the Focolare Movement (Work of Mary) and anyone or any person representing the Focolare Movement (Work of Mary) in any capacity from any claim or cause of action whatsoever arising out of any injury or illness that my child might sustain as a result of participating in the program and activities sponsored by the Focoalre Movement (Work of Mary) or as a result of being on the premises of the Focolare, even though caused as a result of facts whereby such individual or corporations would be responsible under principles of strict liability, negligence or any other theory of liability, except in the case of gross negligence.

In the event my child becomes injured or ill during the program, we authorize the guardian/responsible person named below to secure first aid and/or the services of any legally qualified physican or hospital, and we agree to assume any financial obligations incurred therewith.

MEDIA CONSENT

I authorize the Focolare Movement, during the Midwest Mariapolis, from June 29 to July 3, 2018, to take photographs and/or digital images of my child and publish photos and videos in which our son/daughter may be featured as well as articles containing the experience lived by my son/daughter:

On websites and other publications of the Focolare Movement and other affilitated entitites
In newspaper articles written by the Focolare Movement.

I authorize the use of these images without compensation to me.

All negatives, prints and digital reproductions shall be the property of the Focolare Movement.

Child's Full Legal Name *

Responsible Adult that the child is traveling/attending with: *

Trip Begins on: * +

Arrival Date * +

Return Date * +

Return Destination (city) *

Parent Street Address *

City *

State *

Zip Code *

Parent Home Phone *

Mother's Cell Phone *

Mother's Work Phone *

Father's Cell Phone *

Father's Work Phone *

Alternate Person (someone near to you who could contact you if you are not at home) *

Relationship *

Cell/Home Phone of Alternate Person *

Family Primary Care Physician *

Physician Phone *

Physician Address *

Insurance Company *

Insurance Policy # *

Insurance Group # *

SIGNATURE

By typing and/or writing in your name, you, as parent/legal guardian, give consent and permissions as stated above.

Typed Signature of Parent/Legal Guardian: *

Date * +

Use mouse or, click and hold or, use finger with touch screen to write your electronic signature.

Signature of Parent *

clear

BE SURE TO CLICK NEXT TO GO TO THE NEXT PAGE.

Parent/Guardian Contact Information -Seen when parent is not filling out the form

Parent First Name *

Parent Last Name *

Emergency Number(s) where PARENT can be contacted during the Mariapolis *

PARENT's Email Address *

Mariapolis 2017

Your Primary Contact Information

Country *

USA	Other Country

State *

Enter Country *

Family or Group Instructions

Everyone in your group may have the same contact information.

If that is the case AND you've already entered contact information in a previous submission, check that below to skip entering your address again.

I've already filled in our address information in a previous submission.

Yes

No

Street Address *

City *

Zip Code *

Primary Phone Number *

Phone number where you can be contacted during the Mariapolis *

NOTE: SUBMITTING THIS FORM DOES NOT MAKE A ROOM RESERVATION AT GREEN LAKE CONFERENCE CENTER.

After your submissions are complete, please contact Green Lake to make room and meal arrangments.

Thank you.