Urban
Trip Cost: $150
Join Caroline Rossini and
your friends as we work together right here in our own community. Each day we volunteer
with and learn about several service agencies supported by the Cathedral
Outreach Committee and each night we stay at
Only 15 spaces are
available. Please send in your payment and completed form by March 21, 2011.
Youth Name: _________________________________________
Home Phone: ____________________
Street Address:
________________________________________________________________________
School & Grade: _____________________________________ _________________
Youth Email: ______________________________ &
Cell: _______________ T-shirt Size: _________
Parent/s Name/s & Email/s:
______________________________________________________________
____________________________________________________________________________________
Parent/s Cell #s: ______________________________ __________________________________
Please list any food or other
allergies as well as daily medications: _______________________________
_____________________________________________________________________________________
MEDICAL CONSENT: In the event of a medical emergency, I hereby consent
to the necessary and proper treatment, surgery, and/or anesthetic by a licensed
physician or health care professional. Please
provide a copy of your insurance card with this application.
INSURANCE INFORMATION: I understand that Christ Church Cathedral of
Nashville does not carry
accident insurance, and further, that by signing this form, I
am releasing Christ Church Cathedral and all
of its employees and volunteers from any and all
liability as a direct or indirect result on this trip.
FINANCIAL
RESPONSIBILITY: The cost of the
trip is $150, which covers room, board and supplies for their projects. Please
make checks payable to Christ Church Cathedral. If you need financial
assistance, please contact the Rev. Gene Manning (255-7729 or gmanning@christcathedral.org.)
Parent Signature: _______________________________________________
Date: __________________
Please return form & payment
to: Monica Urness, CCC, 900 Broadway,
Contact Caroline
(crossini@christcathedral.org) or Monica (murness@christcathedral.org) if you
have any questions.
