High School Youth Ministry · St. Patrick & St. Mary’s

Faith in Action: Mission Trip Registration

June 26 to July 2 · Farmington Hills, MI

Dear Families, we are excited that your teen is considering joining us for a mission trip! This experience will give our teens the opportunity to grow in faith, serve others, build friendships, and recognize Christ in the people they meet.

Please complete this registration carefully, as a parent or guardian. The information will help us prepare for a safe, meaningful, and spiritually enriching experience for every participant.

Destination: Farmington Hills, MI
Dates: June 26 to July 2
Depart & return: Church of St. Mary
To secure a spot: $135 (total cost no more than $500, depending on fundraising)
Contacts: Nicole Bacarella, nbacarella@churchofstmary.org
Dianne Marshall, dmarshall@stpatrick-lakeforest.org

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Section 1Teen Participant Information

Please enter your teen’s legal information as it appears on their identification.

Teen’s full legal name ∗

Please enter your teen’s full legal name.

Date of birth ∗

Please enter a date of birth.

School attending (optional)

Home address ∗

Please enter your home address.

Teen’s cell phone (optional)

Teen’s email (optional)

Other size

Parish affiliation ∗

Please enter your parish.

Section 2Parent / Guardian Information

Parent/Guardian 1 full name ∗

Please enter a name.

Relationship to teen ∗

Please enter the relationship.

Primary phone ∗

Please enter a phone number.

Email ∗

Please enter a valid email.

Parent/Guardian 2 full name (optional)

Parent/Guardian 2 phone and email (optional)

Preferred method of communication ∗

Email Text message Phone call

Please choose one.

Emergency contact other than parent/guardian ∗Include full name, relationship to teen, and phone number.

Please enter an emergency contact.

Is there any custody arrangement, court order, or other legal restriction relevant to your teen’s participation, emergency contact, or release to a parent/guardian? ∗

No Yes, I will contact the Youth Ministry Director privately.

Please choose one.

Section 3Medical Information

This helps us respond appropriately if your teen becomes ill or is injured. Medical information is shared only with the designated adults who need it.

Primary care physician and phone number ∗

Please enter a physician and phone number.

Does your teen have any medical conditions or health concerns that trip leaders should know about? ∗

No Yes I would like to discuss this privately

Please choose one.

Please describe any relevant conditions, warning signs, or accommodations needed.

Does your teen have any allergies, including food, medication, insect, or environmental? ∗

No known allergies Yes I would like to discuss this privately

Please choose one.

List allergies and describe any serious reactions or emergency precautions.

Does your teen take medication that may be needed during the trip? ∗

No Yes I would like to discuss this privately

Please choose one.

Medication names, dosing instructions, timing, and any storage or administration needs.

Does your teen have dietary restrictions or food intolerances? ∗

No Yes

Please choose one.

Please describe.

Are there physical limitations, injuries, mental health support needs, accessibility requirements, or other accommodations that would help your teen participate safely? (optional)

Is there anything else our leaders should know to support your teen during the trip? (optional)

Section 4Emergency Medical Authorization

Emergency medical consent. I authorize the designated mission trip leaders to seek emergency medical evaluation and treatment for my teen if I cannot be reached promptly. I understand that reasonable efforts will be made to contact me or the emergency contact listed above, and that medical professionals will make treatment decisions in accordance with applicable law and emergency circumstances.

This consent is required.

Medical information. I certify that the information provided is accurate and complete to the best of my knowledge. I agree to notify the Youth Ministry Director of any relevant changes before departure.

This acknowledgment is required.

Medication and health plan. I agree to follow the parish’s medication, medical documentation, and health-related procedures for the trip, including providing any required medication in its original labeled packaging and submitting necessary instructions or authorizations.

This acknowledgment is required.

Emergency expenses. I understand that I am responsible for applicable medical expenses not covered by insurance, subject to applicable law and the terms of the trip’s approved agreements.

This acknowledgment is required.

Section 5Behavioral Expectations & Catholic Mission

Our mission trip is an opportunity to live out our Catholic faith through prayer, service, community, and respect for others.

Teen Code of Conduct ∗To be read and agreed to by your teen.

I will participate respectfully in service activities, prayer, and group activities.
I will follow leader instructions, curfew, room assignments, and safety rules.
I will treat other participants, leaders, host communities, and property with respect.
I will not possess or use alcohol, tobacco, vaping products, illegal drugs, or other prohibited substances.
I will follow the parish’s rules regarding phones, social media, appropriate conduct, and staying with the group.
I understand that bullying, harassment, violence, leaving the group without permission, or other serious misconduct may result in parent/guardian notification and appropriate disciplinary action, including removal from the trip when necessary and feasible.

I (the teen) have read and agree to the Teen Code of Conduct above.

Your teen’s agreement is required.

Parent/guardian acknowledgment. I have reviewed the mission trip expectations with my teen. I understand that participation requires following the established safety rules and behavioral expectations.

This acknowledgment is required.

Why would your teen like to participate in this mission trip? (optional)

Has your teen participated in a mission trip or service experience before? ∗

Yes No

Please choose one.

Is there anything that would help your teen feel welcomed, supported, or prepared for this experience? (optional)

Section 6Photo & Video

Photos and videos will be taken during the mission trip and may be used in parish publications, on the parish website, and on social media.

Section 7Financial Commitment

Trip cost. I understand that $135 secures my teen’s spot, that the total trip cost is determined by fundraising but should be no more than $500, and that registration is subject to the stated payment deadlines and availability. After I submit this registration, a button will appear to pay the $135 deposit online.

This acknowledgment is required.

After you submit, you’ll get a button to pay the $135 deposit.

Registration received. Thank you!

One last step: your teen’s spot is secured once the $135 deposit is paid.

Pay the $135 Deposit

Thank you for partnering with us to help make this mission trip a safe, faith-filled, and meaningful experience for our teens. We look forward to serving together and growing in Christ!

Be blessed,
Nicole Bacarella, Youth Ministry Director
St. Mary’s and St. Patrick’s