SAVE THE DATE SUNDAY, NOVEMBER 5, :30-6:30 PM $20 ST. BERNARD SCHOOL, UNCASVILLE MIKE PATIN BISHOP COTE JON NIVEN AND LIFT MINISTRIES

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1 YOUTH EXPLOSION - IX SAVE THE DATE SUNDAY, NOVEMBER 5, :30-6:30 PM $20 ST. BERNARD SCHOOL, UNCASVILLE MIKE PATIN BISHOP COTE JON NIVEN AND LIFT MINISTRIES LIZA ROACH DIOCESAN YOUTH MINISTER LROACH@NORWICHDIOCESE.NET

2 Youth Explosion IX Schedule November 5, 2017 Time: Event: Place: 11:30am Doors Open/Registration Lobby 12:30pm YX Begins Auditorium Host Introductions 1:15pm Mike Patin Keynote I Auditorium 2:15pm Adoration Auditorium 3:00pm Break/Snack Gym 3:30pm Mike Patin- Keynote II Auditorium 4:45pm Mass Auditorium 5:30pm Pizza Dinner Gym 5:30pm Optional Reconciliation Classrooms 6:00pm Concert by Jon Nivens & Lift Ministries Auditorium 6:30pm Youth Explosion Ends

3 Youth Explosion XI November 5, 2017 Group Registration Due by 10/20/17 for $20 fee This event is a sell-out; first come, first reserved! Church Name: Leader Contact Info below: Name Address: Phone: Number of tickets requested for youth participants Number of tickets requested for chaperones a. b. List of chaperones must be sent to: Norwich Diocesan Office of Safe Environments before 10/20/17 Total attending Youth Explosion (Add Line a. and b.) *Fee for Youth Explosion (Multiply line c. times $20) c. d. $ After October 15, add $5 per participant e. $ Total fee enclosed (lines d. + e.) $ Make group check payable to Office of Faith Events Our priest,, will be attending the event. (Name) He will be available for confessions? yes no He will concelebrate Mass with Bishop Cote? yes no All tickets are non-refundable AFTER 9/20/17 all tickets are $20 - FIRM For more information, contact Liza Roach, OFE at (860) x305 lroach@norwichdiocese.net or YX website Please send this form with one check per group payable to Office of Faith Events mail to: Office of Faith Events, 199 Broadway, Norwich, CT 06360

4 Procedures for Ensuring Compliance with the Office for Safe Environments (OSE) at Youth Explosion XI All CHAPERONE NAMES MUST BE SENT IN TO THE OFFICE FOR SAFE ENVIRONMENTS BY OCTOBER 20, 2017 FOR YOUTH EXPLOSION. Please provide a copy of this sheet to all adults attending the YOUTH EXPLOSION- To allow for quicker admittance, we ask that ALL Adults participating MUST PRESENT the following item: Government issued Photo ID Procedure for check in of Adults at YOUTH EXPLOSION. 1. All Adults will check-in at registration table. 2. Each adult must show a government issued photo ID. 3. A Chaperone who has not successfully completed the Diocesan Certification for working with children and youth will: a. Sign the Adult Code of Conduct. b. Wear a PURPLE wristband. c. Be paired with an Approved Chaperone to remain with them for the event. 4. A Chaperone who is Certified will: a. Wear the same color as the youth of his or her group. b. If this adult is the group leader, they will receive a verbal OK to pick up the group s packet. ALL YOUTH WILL WEAR A WRISTBAND AS REGISTRATION FOR THE EVENT. Doors will NOT open before 11:30 a.m. at St. Bernard s School Event begins at 12:30 p.m. and concludes at 6:30 p.m.

5 Diocese of Norwich Youth Events Verification Form for Adults from Other Dioceses I,, Safe Environment/Compliance Coordinator for the (Arch) Diocese of, hereby notify the Diocese of Norwich, Connecticut that each adult listed below has been background checked and cleared in accordance with the policies of our (Arch) Diocese under the Charter for the Protection of Children and Young People as set forth by the United States Conference of Catholic Bishops.. I understand that no adult (anyone 18 years and older, and not in high school) will be permitted to be present at any overnight event that has not been cleared by this office and is listed on this declaration. If an adult is not screened and trained (day events only), then adults must be paired so that one adult always has the requisite screening and training. Please notate next to his/her name if not screened and/or trained. A Diocese of Norwich representative will verify names before you are allowed entry to the event. Please bring a valid government issued picture ID. Please print clearly the adult s name below. Name of Event: Diocese of Norwich, Youth Explosion IX Scheduled Event Date: Nov. 5, 2017 Please send this to your Compliance Coordinator of your (Arch) Diocese as soon as possible. No adults will be able to participate in the conference until this compliance form is completed for all adults (anyone 18 years and older, and not in high school). Your registration packets will not be complete until all adults have been cleared by your Compliance Coordinator from your (Arch) Dioceses. If you have further questions please feel free to call the Diocese of Norwich, Office for Safe Environments at (860) ext or-ose@norwichdiocese.net Signature of (Arch) Diocese Coordinator of Safe Environments/Compliance Phone Number Date This form must be received by Office of Safe Environments by October 20, OSE (860) x212 Please return to - OSE 199 Broadway, Norwich, CT or- FAX to (860) or- ose@norwichdiocese.net