CHWC APPLICATION FORM 2026

Catholic Heart Work Camp - a week of faith, fellowship, and service. July12-17 2026. We will be going to Farmington Hills, MI(Detroit).

Student Name Student Name First Last
Nickname
Student Email
Check here if student does not have email

Check here if student does not have email Second option Third option
Student Cell Phone (Required) Student Cell Phone (Required) - ### - ### ####
Check here if student does not have a cell phone

Check here if student does not have a cell phone
Student Home Phone Student Home Phone - ### - ### ####
Date of Birth Date of Birth / MM / DD YYYY
Age at time of Camp
School Grade 2025-2026
Gender
Name of High School
Number of work camps previously attended
Confirmation Saint Name
Favorite Candy/Snack
Why are you interested in attending work camp?
What do you think will be the most challenging aspect of work camp for you?
How would you describe your faith life and your relationship with God?
Please share any major conflicts you have with the work camp formation schedule
Declaration of Comittment to the Parish Work Camp Community
I have read the attached information, and I understand and agree to the responsibilities that must be fulfilled by all OLQP parish WorkCamp participants: 1. Complete and return all paperwork on or before the designated deadlines. 2. Attend and participate in the WorkCamp preparation meetings as detailed on the 2026 WorkCamp Schedule. 3. Commit to Parish and personal fundraising efforts with a spirit of openness. 4. Participate in the building of the parish WorkCamp team through prayer and organized activities. 5. Obtain all the necessary supplies (including footwear, clothing, sleeping bag, etc.) needed for the week. 6. Cooperate with all the guidelines for WorkCamp and be mindful that at all times I am a representative of Our Lady Queen of Peace and the Catholic faith. 7. Abide by the youth WorkCamp code of conduct including items related to dress code, behavior, and cell phone possession. 8. Strive to make the values of WorkCamp a part of my everyday life. 9. Notify the WorkCamp leadership team of any scheduling conflicts at least one week in advance (I understand that I am allowed one absence)
I agree
T-Shirt Size

T-Shirt Size Small Medium Large X-Large XX-Large XXX-Large
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Teen Signature

Draw or Type

I agree to the Declaration of Commitment to the Parish Work Camp Community. Clear

Full Name

I agree to the Declaration of Commitment to the Parish Work Camp Community.
Any Dietary Restrictions? (enter "none, if not applicable)
Any medications/medical Concerns we need to be aware of? (Enter "none," if not applicable. If Yes, please indicate condition, medications being taken and dosage. This information is strictly confidential.)
MEDICAL RELEASE: I agree to indemnify Our Lady Queen of Peace Church, Youth Ministers, Volunteers and the Diocese of Arlington for any costs or expenses arising out of my child’s participation in parish and/or religious education activities, including the cost of any medical care given my child or any expenses or fees incurred in any law suit arising as a result of any damage or injuries caused by my child in the course of his/her participation in the activity.

I further give my consent to that in my absence the above named minor 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 a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor.
I agree
Parent/Guardian Name 1 Parent/Guardian Name 1 Title First Middle Last Suffix
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email
Parent/Guardian 1 Address (enter "same", student lives with you) Parent/Guardian 1 Address (enter "same", student lives with you)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian 2 Parent/Guardian 2 Title First Middle Last Suffix
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email
Catholic Diocese of Arlington Photo, Press, Audio, and Electronic Media Release
I AUTHORIZE The Catholic Diocese of Arlington, its parishes and/or schools to use and publish the photographs and/or motion picture of videotape for which my child has posed, and/or audio recordings made of his/her voice. I agree that the Catholic Diocese of Arlington, its parishes and/or schools may use such photographs of my child with or without his/her name and for any lawful purpose, including, for example, such purposes as publicity, illustration, bulletin and Web content.
Address (enter "same", if student lives with you) Address (enter "same", if student lives with you)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Emergency Contact Title First Last Suffix
Emergency Contact Cell Phone Emergency Contact Cell Phone - ### - ### ####
Emergency Contact Email
Multiple Choice

Multiple Choice I agree I disagree
Multiple Choice

Multiple Choice I agree
Parent Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.