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PHONG TRÀO THIẾU NHI THÁNH THỂ VIỆT NAM TẠI HOA KỲ The Vietnamese Eucharistic Youth Society in the USA Miền Đông Nam - Southeastern Region

ĐOÀN PHÊRÔ & PHAOLÔ 15 West Par Street ♦ Orlando, Florida 32804 ♦ (407) 451-6574 tranndung@gmail.com

THÖ XIN PHEÙP Kính gởi: Quý Phụ Huynh Trích yếu: V/v Lock-in: Time with Jesus Được sự chấp thuận của Cha Tuyên Úy Giuse Nguyễn Thanh Châu, đoàn Thiếu Nhi Thánh Thể Phêrô & Phaolô sẽ tổ chức Lock-in: Time with Jesus dành riêng cho các em ngành Hiệp Sĩ và Nghĩa Sĩ. Mục đích của Lock-in: Time with Jesus là để tạo cơ hội cho các em học hỏi thêm về Chúa Giêsu để chuẩn bị cho Mùa Chay sắp tới qua chương trình Praise and Worship, giờ viếng Thánh Thể, những giờ chia sẻ, cũng như những sinh hoạt tập thể và trò chơi thi đua lành mạnh tại nhà thờ. Chúng con xin quý phụ huynh cho phép các em được tham dự chương trình này. Thêm vào đó, chúng con cũng xin quý phụ huynh tham dự với chúng con để cùng đồng hành với các em. Nếu quý phụ huynh nào có thể tham gia với chúng con để làm những người hướng dẫn hay giữ trật tự, xin quý phụ huynh liên lạc với các trưởng trong Ban Tổ Chức. Thời gian:

từ 5:30 giờ chiều, Thứ Bảy ngày 26 tháng 2 năm 2011 đến 10:00 giờ sáng, Chúa Nhật ngày 27 tháng 2 năm 2011

Địa Điểm:

Nhà thờ Giáo Xứ Thánh Philípphê Phan Văn Minh 15 W Par St., Orlando, Florida 32804

Điều kiện để tham dự: 1. 2. 3. 4. Liên lạc:

Nộp đơn trước ngày 15 tháng 2 năm 2011 Ưu tiên cho 30 em nộp đơn sớm nhất (first-come, first-serve) Lệ phí: $5 mỗi em (Xin ký checks payable to: HOAN NGUYEN) Lock-in chỉ dành riêng cho các em Hiệp Sĩ và Nghĩa Sĩ. Tr. Tôma Trần Ngọc Dũng (407) 451-6574 ♦ tranndung@gmail.com Tr. Maria Nguyễn Thêu Trang (407) 733-3957 ♦ doanpherophaolo@gmail.com

Xin chân thành cám ơn. Kiến thị

Lm. Giuse Nguyễn Thanh Châu Tuyên Úy Đoàn

Ban Thường Vụ Đoàn

Tôma Trần Ngọc Dũng Đoàn Trưởng


PHONG TRÀO THIẾU NHI THÁNH THỂ VIỆT NAM TẠI HOA KỲ The Vietnamese Eucharistic Youth Society in the USA Miền Đông Nam - Southeastern Region

ĐOÀN PHÊRÔ & PHAOLÔ 15 West Par Street ♦ Orlando, Florida 32804 ♦ (407) 451-6574 tranndung@gmail.com

ÑÔN GHI DANH Lock-in: TIME with JESUS Tên Thánh:

_____________________

Tên:

Saint Name

Ngày Sinh:

_____________

Full Name

Địa Chỉ:

Birth Date

Thành Phố:

___________________________________________

________________________________________________ Address

_________________________

Bưu Mã:

City

Hiệp Sĩ

Ngành:

Nam

________________ Zip Code

Nữ

Gender

Nghĩa Sĩ

Cha/Mẹ/Người Giám Hộ (Parents/Guardians) Tên:

_______________________________________________________________ Full Name

Điện Thoại:

__________________

Điện Thư:

_________________________

Telephone

Chi Phiếu xin đề cho HOAN NGUYEN

Email

Official Use only

Deadline is Feb 15th. Forms will be accepted

Ủng hộ $ _________

on a first-come, first-served basis.

Tiền lệ phí đính kèm $ _________

--------------------------------------------------------------------------------------------------------------------Đơn Xin Phép Sẽ Vô Hiệu Lực Nếu Không Miễn Bỏ Quyền Kiến Tụng và Chữ Ký (This application will not be accepted if this waiver is not signed) I, ___________________________________________, have read and understand clearly that by signing this waiver, I will be forever prevented from suing the Camp Community or anyone who supports it. My signature below, I certified that I will hold all responsibilities for any predicament(s) that might happen to my son/daughter at the camp.

Ký Tên:

_________________________________ Ngày, tháng, năm: Signature of Parent or Participant if over 18

________________ Date


PHONG TRÀO THIẾU NHI THÁNH THỂ VIỆT NAM TẠI HOA KỲ The Vietnamese Eucharistic Youth Society in the USA Miền Đông Nam - Southeastern Region

ĐOÀN PHÊRÔ & PHAOLÔ 15 West Par Street ♦ Orlando, Florida 32804 ♦ (407) 451-6574 tranndung@gmail.com

VOLUNTARY ACTIVITIES PARTICIPATION FORM Lock-in: TIME with JESUS If Participant is a minor, then parent or guardian must sign. If Participant is an adult, no signature of parent or guardian is required. A signed VOLUNTARY ACTIVITIES PARTICIPATION FORM must be on file with the Local Church/Diocese before Participant will be allowed to participate in this Activity. (Participants and/or parents/guardians who do not wish to accept the risks described in this agreement should not sign this agreement, and will not be allowed to participate.) I, the undersigned _______________________________________________, ("Participant") wish to participate in the Lock-in: Time with Jesus at St. Philip Phan Văn Minh Church from Saturday 2/26/2011 to Sunday 2/27/2011 with Đoàn Phêrô & Phaolô of the Vietnamese Eucharistic Youth Society in the U.S.A. (VEYS) (hereinafter "Activity"). IF UNDER 18 YEARS OF AGE, my parent or guardian authorizes my participation in this activity. I understand and acknowledge that this Activity may be dangerous and hazardous and, by its very nature pose the potential risk of severe and serious physical and emotional injury/illness, or even death, to all individuals who participate in such Activity. I understand and acknowledge that in order to participate in this Activity I agree to ASSUME ALL LIABILITY AND RESPONSIBILITY for any and all potential risks, injuries, or even death which may be associated with participation in such Activity. I represent and warrant that Student/Participant is mentally and physically fit, capable, able, and willing to participate in this Activity without any limitations. I understand, acknowledge, and agree that the VEYS, its trustees, employees, agents, coaches, teachers, volunteers, or representatives shall not be liable for any injury/illness suffered by Participant which is incident to and/or associated with preparing for and/or participating in this Activity. I hereby release, discharge, indemnify, and agree to hold harmless VEYS, VEYS’ governing board ("Board"), and each of their trustees, employees, agents, coaches, teachers, volunteers, and representatives free from any and all liability arising out of or in connection with Student/Participant's participation in this Activity, including all related activity such as games, practices, training activities, trips and related exercise. For purpose of this RELEASE, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that Participant or Participant's parents, guardians, heirs, executors, administrators, and assigns may have against VEYS, Board, and their trustees, employees, agents, coaches, teachers, volunteers, and representatives because of Participant's personal, physical or emotional, injury, accident, illness, or death, or because of any loss of or damage to property that occurs to Participant or his or her property during Participant's participation in the Activity that may result from any cause including but not limited to VEYS’, Board's, trustees', employees', agents', coaches', teachers', volunteers', or representatives' own passive or active negligence or other acts other than fraud, willful misconduct or violation of the law. I acknowledge that I have carefully read this VOLUNTARY ACTIVITIES PARTICIPATION FORM and that I understand the potential dangers incident to engaging in the Activity, am fully aware of the legal consequences of this agreement, and agree to its terms and understand I am waiving certain rights and assuming the risk of damage from my participation in the Activity. Parent/Guardian’s Full Name: _____________________________________________ Signature of Parent/Guardian: ______________________________________ Date: ___________________________


PHONG TRÀO THIẾU NHI THÁNH THỂ VIỆT NAM TẠI HOA KỲ The Vietnamese Eucharistic Youth Society in the USA Miền Đông Nam - Southeastern Region

ĐOÀN PHÊRÔ & PHAOLÔ 15 West Par Street ♦ Orlando, Florida 32804 ♦ (407) 451-6574 tranndung@gmail.com

MEDICAL RELEASE FORM Lock-in: TIME with JESUS Name of Participant: ___________________________________________ Date of Birth: _______________________ Address: _________________________________________________________________________________________ _________________________________________________________________________________________________

Insurance Carrier: _______________________________ Insurance Policy Number: __________________________ Insurance is provided by which parent and/or employment? _______________________________________________ Address and Phone Number of Company: _____________________________________________________________

Relative or friend to contact if unable to reach parent/guardian in the event of emergency (over 18) Name: _________________________________________ Relationship: ____________________________________ Home Phone: ____________________________

Cell Phone: ______________________________

Special consideration to be aware of (i.e. allergies, medical conditions, etc.): _________________________________________________________________________________________________ Medication (and dosage) my son/daughter is currently taking: _________________________________________________________________________________________________ As the parent/legal guardian of, _____________________________________________, I request that in my absence the above named participant be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given guarantee as to the results of examination or treatment; I authorize the hospital of medical facility to dispose of any specimen or tissue taken from the above named player.

Signature of Parent/Guardian: __________________________________

Date:

_________________

**Please photocopy insurance card that is to be used and attach it to this form** EITHER A PHYSICIAN’S PRESCRIPTION OR PARENT NOTE MUST ACCOMPANY ALL MEDICATIONS. PRESCRIPTION/NOTE SHOULD BE ATTACHED TO THIS FORM.


Lock-in: Time with Jesus Forms