2026 YOUNG DISCIPLES WORK CAMP REGISTRATION FORM

OLQP Young Disciples Work Camp - a week of faith, fellowship, and service at OLQP, June 22-26, 2026. Cost of camp is $125. $50 deposit reserves camp spot.

Student Name Student Name First Last
Nickname
Date of Birth Date of Birth / MM / DD YYYY
Current Grade
Gender
T-Shirt Size

T-Shirt Size Small Medium Large X-Large XX-Large XXX-Large
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Student Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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.

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 consent
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.
I consent I do not consent
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
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