Happening Application

Name _________________________________________________________________

Social Security # ________________________________________________________

Age ________  M/F ________  Grade __________  Graduation Year ______________

Address _______________________________________________________________

City ____________________________________ State ___________ Zip ___________

Phone # ________________________ T-Shirt Size _____________________________

Email _________________________________________________________________

Church ________________________________________________________________

  Baptized?  Y/N ________  Confirmed?  Y/N _____________

Parent/Guardian(s) Name(s)  _______________________________________________

_______________________________________________________________________

_______________________________________________________________________

Adult & Youth Participants sign:

I agree to abstain from the use of any alcohol, illegal substances and inappropriate prescription medication while at Happening.  I also agree to fully participate in all activities.

Signature/Date _________________________________________________________

Parent/Guardian signs:

I give the above named child for whom I am legally responsible permission to attend Happening held at the Cathedral Domain and sponsored by the Episcopal Diocese of Lexington.

I give my permission for the use of any photography or video that includes my child’s image or likeness to be used publicly by the Cathedral Domain or the Diocese of the Lexington.  I grant permission for the said child to be treated by medical personnel.  I agree to hold harmless all representatives of the Cathedral Domain and/or Episcopal Diocese of Lexington in regard to accident or injury involving the above named child at Happening.

Signature/Date __________________________________________________________

Clergy Signs:

I am aware this person from my congregation is attending Happening.  I will support this person in his/her walk with Christ.

Signature/Date __________________________________________________________