Episcopal Diocese of Central New York
New Beginnings Team Application - *Youth* (younger than 18 years)
Spring 2017 Weekend
March 17-19, 2017
at St. Paul’s, Owego
Registration Deadline – Feb. 25th
Fee: NO COST
Team Meeting – March 5th 1-4pm
at St. Paul’s, Owego
Fall 2017 Weekend
TBD
Fee: NO COST
 What is NEW BEGINNINGS? It is a unique weekend especially designed to respond to the
issues, concerns and needs of young people in grades 6 through 8. It was created in the
Episcopal Diocese of Central Florida by adults and young people to help participants grow
in their love of themselves and the Lord Jesus Christ.
 NEW BEGINNINGS requires the hard work and dedication of adults and youth who want
to see Junior High School students get closer to Jesus and to each other. The main reason
that this program has proven to work so well, is the involvement of Senior High and
College age young people ministering to the participants.
 Team members in 9th grade will be our Guardian Angels/Leaders in Training. They will
assist the group leaders in discussions while making sure they have needed materials.
 Each team member will be required to read and sign a contract attached to this
application agreeing to the rules and expectations that will be enforced throughout the
weekend. Failure to comply with these rules and receiving three strikes can result in
termination from the weekend and would be sent home immediately.
 Attendance is mandatory at the team meeting. If you can not make this meeting, please
do not apply to be on team. This meeting is necessary for preparations and planning to
get ready for a fabulous New Beginnings weekend.
 Weekend Fee $0.00 – It is Policy to mail your $0.00 (Check payable to: Diocese of Central
New York) with this form. If the fee is not received by the team meeting you will not be
allowed to serve on this New Beginnings Weekend Retreat.
 All team members work together, with a Weekend Advisor, Other Adults, and a Spiritual
Director to ensure that the participants have the best weekend possible. Each team
member is important and necessary for a NEW BEGINNINGS weekend.
All Youth Team Members must complete Safe Church training every year.
Personal Information
Date of Safe Church Training and Trainer:__________________________________________________
Please Print
Name: _______________________________________________________________________________________
First
Middle
Last
Nickname: ___________________________________________________________________________________
Gender: ___________
Current Grade: _______
Age: _________
Date of Birth: _______________
Street Address: _______________________________________________________________________________
City: _________________________________________
State: ____________
Zip: ___________________
E-mail: _______________________________________________________________________________________
Primary Phone Number: ____________________
Secondary Phone Number: ____________________
Church: ____________________________________________
Town: ________________________________
Parent/Guardian Name(s): ____________________________________________________________________
Parent/Guardian Phone Numbers: ____________________________________________________________
Parent/Guardian E-mail: _____________________________________________________________________
Primary Emergency Contact: __________________________________________________________________
Contact Phone Numbers: _______________________________________________________________
Address: _______________________________________________________________________________
Street
City
Zip Code
Secondary Emergency Contact: _______________________________________________________________
Contact Phone Numbers: _______________________________________________________________
Address: _______________________________________________________________________________
Street
City
Zip Code
Leadership
Church: __________________________
Town: _________________
Clergy Name: _________________
How often do you attend church? _____________________________________________________________
Which New Beginnings weekends have you been on? __________________________________________
Are you currently serving on Happening Team? ________________________________________________
Or any other ministry in the diocese? _____________________________________________
What are your strengths/talents?
_____ Leadership
_____ Good listener
_____ Speaker
_____ Good in front of a group
_____
_____
_____
_____
Writing
_____ Morning Person
Organization
_____ Singer
Guitar Player
_____ Acting
Other: ______________________________________________
In what situations do you feel most comfortable?
_____ Leading a large group with little individual contact.
_____ Relating to a small group of about 6 people.
_____ Talking one to one with an individual.
_____ Comfortable in any.
Why do you want to be on NEW BEGINNINGS team? __________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
How do you define leadership? _______________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Any additional comments:
______________________________________________________________________________________________
______________________________________________________________________________________________
**Filling out this application does not ensure a spot on the NEW BEGINNINGS team. It is
a guide for the Weekend Advisor to use when selecting the team. Please be sure to fill it
out completely. The more you describe yourself, the more information we have to make
our decision. Team selection happens 1-2 weeks before the team meeting. You will be
notified if you are chosen for team. It is an honor and a privilege to be selected for team
as you are representing the New Beginnings program and the diocese. It should be
known that those selected for team will have the utmost respect for the leaders and be a
valuable asset with leadership qualities instead of a hindrance to the leaders and
program as a whole.
LIABILITY RELEASE
I hereby give permission for my minor child (anyone under 18 or not graduated high school)
_______________________________ to participate in the Episcopal Diocese of Central New York Program
“New Beginnings” to be held at various churches in our diocese. In consideration of permitting my
minor child to participate in the described event I hereby agree to indemnify and hold the Episcopal
Diocese of Central New York, its employees and agents harmless from any and all liability as a result
of being injured while participating in the above activity. I acknowledge that if my child is required to
travel by van, car or bus or airplane I will assume all risks in connection therewith.
Parent/Guardian Name(s): ________________________________________________________________________
(Please Print)
Signed: _____________________________________________________________
Date: _____________________
(Parent/Guardian)
I also understand that my son/daughter will be photographed on this weekend and I give full release for
these photographs to be published throughout the Diocese whether in the Diocesan Newspaper, Website,
Social Media, and in Parishes. If you object, please let me know!
MEDICAL RELEASE
In the event I/we cannot be reached during a medical emergency or following any accident: I authorize
the Episcopal Diocese of Central New York to act on my/our behalf in carrying out the best treatment
possible in consultation with my child’s attending board certified and licensed physician or surgeon at an
accredited Hospital. I assume all responsibility for costs if medical care is provided to my child.
Parent/Guardian Name(s): ________________________________________________________________________
(Please Print)
Signed: _____________________________________________________________
Date: _____________________
(Parent/Guardian)
Any prescription medications that your minor child will be taking during this event
MEDICAL
RECORD to the Event Chaperones. The
must be dropped off by the Diocesan
Chaperones
following medications will be available for your minor child to take with your
permission. I the parent/guardian of ________________________________ give permission
for my child to take:
Please Check Yes or No for each of the listed medications!
Cough Drops
Tylenol
Motrin
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Mylanta
Benadryl
Yes ____ No ____
Yes ____ No ____
Medical Insurance Company & Policy #: ___________________________________________________________
Known Allergies or Medical Conditions: ___________________________________________________________
Current medications ______________________________________________________________________________
Operations or Major Illness (specify problem & date): ______________________________________________
Physical Limitations (if any): ______________________________________________________________________
My child has the following food restrictions: _______________________________________________________
Last Tetanus Booster Shot (Specific Date within 5 years): ________________________________________
Physician’s name (print): __________________________________________________________________________
Address: ___________________________________________________
Telephone: ________________________
Parent/Guardian Signature: _________________________________________
Date: ____________________
FINANCIAL COMMITMENT
The cost to attend New Beginnings in the Episcopal Diocese of Central New York is currently $45.00.
This fee is subsidized by the Diocesan youth budget. Youth needing financial assistance are
encouraged to first speak to their parish clergy and then Kristen Blum at:
[email protected]. The Diocesan Youth Scholarship is as follows:
RESOLVED, that no youth will be denied participation in any youth event
based on financial difficulties, and be it further.
RESOLVED, that diocesan scholarships for youth events be available to
youth at a maximum of thirty dollars ($30) per event with an annual
maximum per person of ninety dollars ($90) per year, defined as September
1st through August 31st. Diocesan scholarships are available after financial
contributions are sought from the individual, their family and their parish.
Adopted – May 24, 2005
My family will be paying:
My Parish will be paying:
Diocesan (**) Scholarship for:
$________FREE__________
$_________FREE_____________
$_________FREE_____________
___________________________
________________________
Parent/Guardian Signature
Rector’s Signature
**This is not assumed, please contact Kristen Blum at: [email protected] and ask for this assistance.**
 Attendance is mandatory at the team meeting. If you can not make this meeting, please
do not apply to be on team. Team members are required to pay for their weekend. The cost
is $0.00. Scholarships are available.
 Team Participant Weekend Fee $0.00
 Make Check Payable to: Diocese of Central New York
 If fee is not received by the team meeting you will not be
allowed to serve on this New Beginnings Weekend Retreat.
Make Checks Payable to: Diocese
of Central New York
PLEASE MAIL APPLICATIONS AND CHECKS TO:
Mrs. Kristen Blum
Attn: New Beginnings Retreat
1818 East Lake Road
Skaneateles, NY 13152
Total Due: $0.00
Date Received: _____________________
Amt. Received: _____________________
Check #:____________________________
Personal: _________ Church: ________
NEW BEGINNINGS CONTRACT FOR TEAM MEMBERS
1. NO Cell Phones (or other internet based devices) on your person during the weekend.
They will be collected and held for the entire duration of the weekend. If I catch you
with it, I will take it away immediately.
2. NO sharing personal information with the participants. The weekend is for them not for
you. You’ve had your weekend, let them have theirs. If you need to talk to someone
please pull myself, another adult, or the spiritual director privately so we can help you.
3. I will be an active team member and interact with participants on free/down time. I
understand it is not a time for me to disappear and be on my own or with other team
members.
4. NO participants hanging out in team members’ room and no team members hanging out
in participants’ rooms.
5. NO hanging out with just team members. You need to be dispersed amongst the
participants, not always next to each other. This includes meals, singing, discussions, and
small group activities.
6. Be respectful of the Weekend Advisor, other adult leaders, and the spiritual director. I
am there to assist them and interact with the participants.
Please read contract above and cut on dotted line. Sign the bottom half agreeing to the rules and expectations and submit
with your application. Failure to comply with this contract can result in termination and will be sent home immediately.
NEW BEGINNINGS CONTRACT FOR TEAM MEMBERS
1. NO Cell Phones (or other internet based devices) on your person during the weekend.
They will be collected and held for the entire duration of the weekend. If I catch you
with it, I will take it away immediately.
2. NO sharing personal information with the participants. The weekend is for them not for
you. You’ve had your weekend, let them have theirs. If you need to talk to someone
please pull myself, another adult, or the spiritual director privately so we can help you.
3. I will be an active team member and interact with participants on free/down time. I
understand it is not a time for me to disappear and be on my own or with other team
members.
4. NO participants hanging out in team members’ room and no team members hanging out
in participants’ rooms.
5. NO hanging out with just team members. You need to be dispersed amongst the
participants, not always next to each other. This includes meals, singing, discussions, and
small group activities.
6. Be respectful of the Weekend Advisor, other adult leaders, and the spiritual director. I
am there to assist them and interact with the participants.
I agree to the above rules and expectations. I understand that if I get three strikes my role as a team
member can be terminated and I can be sent home immediately. I should feel honored to be on team
and I will hold up my end of the deal by following the rules and expectations that are clearly established.
________________________________________________
signature
____________________
date
YOUTH MINISTER’S OR RECTOR’S RECOMMENDATION
(REQUIRED FOR FIRST TIME TEAM MEMBERS-OPTIONAL FOR RETURNING TEAM MEMBERS)
THIS FORM MAY NOT BE FILLED OUT BY A PARENT OR GUARDIAN OF THE STATED PARTICIPANT
Name of Participant: _____________________________________________________________________________
Name of Youth Minister or Rector: ________________________________________________________________
Parish: ____________________________________________
Telephone: (______) _________________________
The above named person has applied to be a Team member for the next New Beginnings Weekend.
We would appreciate your remarks and recommendation (or non-recommendation) of this person. All
comments will remain confidential.
This sheet is used by the New Beginnings Weekend Advisor to help inform them about the person,
and is used in the planning process for the weekend. Thank you for your assistance.
Brief description of applicant’s participation in church including attendance, youth group, acolyting,
etc: ______________________________________________________________________________________________
__________________________________________________________________________________________________
Are there other activities this person is involved in and to what degree? (Ex: work, school, other)
_________________________________________________________________________________________________
__________________________________________________________________________________________________
Is there anything that you are aware of that may indicate this person may not be ready to participate
at this time? _____________________________________________________________________________________
__________________________________________________________________________________________________
Any other comments:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Do you recommend this young person?
_____ Yes
_____ Not at this time
Has this person attended the mandatory Safe Church training in the past year?
_____ Yes
_____ No
_______________________________________
Youth Minister’s or Rector’s Signature
Mail to:
Mrs. Kristen Blum
Attn: New Beginnings Retreat
1818 East Lake Road
Skaneateles, NY 13152
_________________
Date