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- The Journey /
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The Journey - Why did they come?
High School Youth Pilgrimage to St. Clement's Island
September 24, 2022 - Colton's Point MD
Registration Form

Registration (Please Register as a Group if Possible)

Read all information below before completeing the registration form.

Every participant is required to be accompanied by a chaperone. A chaperone can be a Parent/Guardian, Teacher, and or a Youth Minister. Parents/Guardians, Teachers and Youth Ministers must complete and submit this form with payment of $45 per person. (Chaperones are required to pay $45 and each participant must pay $45.) Youth Ministers/Teachers must be Virtus certified and have a 1 to 10 ratio of Chaperone to youth participants. (There can be no more that 10 students per 1 chaperone.) All shirts are unisex and we can only offer up to the 2XLarge size.

If your youth participant would like to join a group that already has a chaperone please click the $0.00 amount under the "Chaperone or Adding to a Chaperone" field. We recommend that groups sign up together if possible and not individually. If you are a group of 1 youth participant then you are still required to be chaperoned (Parent/Guardian, Youth Minister, or Teacher) and can still use this form to register.

If you have any questions regarding this form please email us at southernmarylandroot@gmail.com .

Scholarship assistance, to help pay for this event is available. Please contact Theresa Friess at southernmarylandroots@gmail.com for more information.

Need a Faith centered place to spend the night? Book a reservation today with Camp Maria Retreat Center, a ministry of the Sisters of Charity of Nazareth.
The maximum number of form submissions has been reached. This form is currently not available.
- Chaperone Participant - Every youth participant must be accompanied by a chaperone. No more than 10 youth participants are allowed per each chaperone participant. In the following fields please enter the chaperone information. All chaperone participants must be Virtus certified, unless the chaperone is the parent/guardian of the youth participant. If a parent is the chaperone of a youth participant that is not a legal dependant then they must be Virtus certified. Chaperones must also complete the Adult Waiver form located toward the bottom of this page and email it to southernmarylandroots@gmail.com.
- Chaperone or Adding to a Chaperone REQUIRED Please fill out this field.
- Chaperone Information - All youth must have a chaperone.
- Choose Your Chaperone Role REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parish or School Name REQUIRED Please fill out this field. Please enter valid data.
- Parish or School City, State, and Zip
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Chaperone Email REQUIRED Please fill out this field. Please enter an email address.
- Chaperone Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Gender
- T Shirt Size (Shirts are Unisex, Sizes larger than XXL are not available.) REQUIRED Please fill out this field.
- Are you Virtus certified? REQUIRED Please fill out this field.
- Youth and Parent Information: Please use the space below to register up to ten (10) participants not including the chaperone (parents/guardians, youth ministers, and teachers). Under the "Participants field use the up and down arrows to add up to 10 child participants. Each youth participant is required to complete the Parent/Guardian Waiver for located toward the bottom of this page and email the completed form to southernmarylandroots@gmail.com .
- Youth Participants REQUIRED Please fill out this field.
  
  Youth Participant 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Youth Participant 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  T Shirt Size (All Shirts are Unisex, Sizes larger than XX-Large are not available.) REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Youth Participants45.0
- I have read the guidelines and regulations provided in the waiver documents and agree to abide by all as required to attend this event. I agree to email a complete Parent/Guardian Waiver form for each participant and a Adult Waiver form for every adult participating. (Forms Below. Email to southernmarylandroots@gmail.com.)
  I Agree Please select this field.
Total:

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Proceed to Payment

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REQUIRED FORMS - PLEASE COMPLETE THE APPROPRIATE FORM AND EMAIL TO SOUTHERNMARYLANDROOTS@GMAIL.COM
- Parent/Guardian Waiver Form
- Adult Waiver Form
Schedule of Events
- Event Agenda
- Know Before You Go

Southern Maryland Roots Youth Group

Chaptico, MD

Click Here

REQUIRED FORMS - PLEASE COMPLETE THE APPROPRIATE FORM AND EMAIL TO SOUTHERNMARYLANDROOTS@GMAIL.COM

Schedule of Events