UBE Youth Day Trip To San Antonio - Registration Form

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Youth Name(s) and Grade Level. Please also include youth cell phone and email, if applicable.

Transportation

Yes, I (parent/guardian) am driving and joining the tour! Yes, I will bring them to/from San Antonio, and will pick them up at the end of the trip Yes, my high school age youth is driving themselves to/from San Antonio My child/children AND I would like to attend, but we need transportation I'd like my child/children to attend, but I cannot attend the trip with them. Can they carpool with someone?

Important Information

Who do we contact in case of an emergency (please someone who lives outside of your home). Please list name, phone, email.

Please list any allergies (food, medicine, other)

Is there anything else you'd like us to know?

Authorization and Consent for Medical Treatment

I grant my authorization and consent for St James’ Episcopal Church staff and Union of Black Episcopalians - Myra McDaniel Chapter to administer general first aid treatment of any minor injuries or illnesses experienced. I understand in an emergency situation, emergency services will be contacted.

Do we have permission to administer general first aid treatment of any minor injuries or illnesses experienced by you and/or your child?

Yes No

Media Release

I understand that photos or videos or audio of me and/or my child may be taken during this event. I consent to the use of my and my child's photo, voice, or likeness in promotional materials such as the church website, newsletter, brochures, bulletin, and social media outlets. I understand that my child's identifying information will not be provided unless I give permission at a later time.

Do we have permission to photograph and record you and your child?

Yes No

Parent/Guardian digital signature

Type the full name of legal guardian

Today's Date

Description

March 5, 2022, 9 am to 6 pm

Please fill out this form and click submit.

The Myra McDaniel Chapter of the Union of Black Episcopalians (UBE) is sponsoring a trip for the Middle and High School Youth on Saturday March 5, 2022.

The group will meet in St. James’s parking lot at 9:00 am and caravan to San Antonio to visit and tour St. Philip’s College in San Antonio to see the Blessed Artemisia Bowden Gallery, a visit to the San Antonio African American Community Museum, and lunch, then return to St James'. (Return time is estimated. Depending on how long the tours are and traffic, we will likely return sometime after 5 pm, no later than 6pm.) The trip, including lunch, is provided by UBE, at no cost to youth/families.

We will continue to follow our St James' Covid guidelines, and will wear masks when indoors, including when inside shared vehicles. We ask that families opt to caravan whenever possible (due to Covid). Carpool space is limited.

UBE Youth Day Trip To San Antonio - Registration Form

Description

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