2025 CHWC APPLICATION FORM

Catholic Heart Work Camp - encountering Christ through a week of faith, fellowship, and service. July 13-19, Morganton, NC. The cost of the trip is $375 - financial assistance is available. Completion of form and $100 deposit reserves a spot - space is limited. Register today!

Name Name First Last
Nickname
Date of Birth Date of Birth / MM / DD YYYY
Email
Cell Cell - ### - ### ####
Checkboxes

Checkboxes Teen does not have a cell
Grade 2024-2025
Name of High School
Confirmation Name (if not confirmation, put "none")
Number of Work Camps previously attended
T-Shirt Size

T-Shirt Size Small Medium Large XL 2XL 3XL
Favorite Candy/Snack
Home Phone Home Phone - ### - ### ####
Any Dietary Restrictions? (enter "none, if not applicable)
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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
Photo, Press, Audio, and Electronic Media Release:
I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes.
I agree I do not agree
Parent/Guardian Cell Phone (Required for teen applicants) Parent/Guardian Cell Phone (Required for teen applicants) - ### - ### ####
Parent/Guardian Name 1(Required for teen applicants) Parent/Guardian Name 1(Required for teen applicants) Title First Middle Last Suffix
Home Phone Home Phone - ### - ### ####
Parent/Guardian Email(Required for teen applicants)
Parent/Guardian 1 Address (enter "same", if student lives with you) Parent/Guardian 1 Address (enter "same", if 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 (Required for teen applicants) Cell Phone (Required for teen applicants) - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email (Required for teen applicants)
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
Relationship to Applicant
Emergency Contact Cell Phone Emergency Contact Cell Phone - ### - ### ####
Emergency Contact Email
Why are you interested in attending Catholic Heart Work Camp?
What do you think will be the most challenging aspect for you?
How would you describe your faith life and your relationship with God? (There is no wrong answer.)
Declaration od Commitment of the Parish Work Camp Community
I agree to the responsibilities that must be fulfilled by all OLQP Work Camp participants: 1. Complete and return all paperwork/electronic paperwork on or before the designated deadlines. 2. Attend and participate in the CHWC preparation meetings. 3. Commit to Parish and personal fundraising efforts with a spirit of openness. 4. Participate in the building of parish workcamp team through prayer and organized activities 5. Obtain all the necessary tools and supplies (Including footwear, clothing, sleeping bag, etc.) needed for the week. 6. Cooperate with all the guidelines for CHWC and be mindful that at all times I am a representative of the Diocese of Arlington, Our Lady Queen of Peace, and the Catholic faith. 7. Abide by the CHWC code of conduct including items related to dress code, behavior, and cell phone possession. 8. Strive to make the values of Work Camp a part of my every day life.
I agree
Work Camp participant - draw your signature into the box below.

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.
Parent/Guardian signature (Required for campers under the age of 18) - draw your signature in the box below.

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.