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1 INCLUDED IN THIS DOCUMENT Welcome from the Team Church Information Form (for adult leader only) Participant Registration & Medical Release Form (All youth & adults) Participant Covenant (All youth) Event Registration Instructions FAQ s Main Speaker and Location Info Registration Process: 1. Register online at 2. Pay online or send one Church check payable to Pacific Southwest District. Pacific Southwest District Att: Dave Rueter Jr. High 1540 Concordia E Irvine, CA all forms to the registrar, Kyle Salesky: ksalesky@abidingsavior.com. Deadlines: Early Registration: $75 pp postmarked by January 27, 2017 Late Registration: $85 pp postmarked by February 10, 2017 Hotel Info: Watch for hotel info. Payment: Hotel costs are to be paid directly to the hotel. Watch for downloadable schedule, posters & more.

2 Group Leaders: Welcome to the 2017 Junior High District Youth Gathering (DYG) Faith Awakens March 11-12th, 2017! We are once again back on the campus of Concordia University Irvine for this year s event. The theme for this year s Jr. High Gathering is Faith Awakens based on Acts 2. Our speaker, Pastor Tom Park, professor of theology at Concordia University Irvine, will bring to life how, through the holy spirit our faith becomes alive. As we have done last couple years, we are planning to provide breakout sessions along with time for your group to meet together to process their learning or walk through additional teaching you provide. Groups will be assigned the order in which they will participate in the afternoon breakout sessions. Break outs will be organized in a three track system. Additional free time is planned that will provide your group with a time to debrief the day or handle confirmation related work. As our committee continues to plan and carry out preparations for the gathering, we continue to pray for each of you, your ministry, and your youth. We pray for the Lord's infinite wisdom as we strive to provide a Junior High DYG that will bring adults and Junior High students to a deeper connection with our Savior. If there are any questions or concerns, please feel free to contact me. Thank you and we look forward to seeing you in March! Peace in Christ, Timothy Potthoff, Hephatha, Anaheim Hills Chair tpotthoff@hephatha.net Kyle Salesky, Abiding Savior, Lake Forest Registration- ksalesky@abidingsavior.com Noel Fairchild, Light of Christ, Irvine dcenoel@gmail.com Dave Rueter, Pacific Southwest District david.rueter@psd-lcms.org

3 CHURCH INFORMATION Name: Address: City/St/Zip CONTACT PERSON INFORMATION: Name: Title: Phone: CHURCH INFORMATION FORM REGISTRATION FEES DUE Early Registration: $75 pp postmarked by January 27, 2017 Late Registration: $85 pp postmarked by February 10, 2017 (Included in the price of registration is cosmic bowling Saturday night and two slices of cheese pizza and a drink.) # of Participants Registration Fee Total Due X = DYG T-SHIRT SIZES (included in reg. cost!) Size Small Medium Large X-Large XX-Large* XXX-Large* *$3.00 charge Quantity Cancellation: A $40 charge per person will be retained for cancellations made on or before February 10, NO refunds will be issued as of February 10. Please contact Kyle Salesky if you have any substitutions. Make Checks Payable to Pacific Southwest District (no personal checks) Return all forms and payment to: Pacific Southwest District Attn: Dave Rueter Jr. High 1540 Concordia E Irvine, CA ** Register ONLINE at ** Office Use: Acct

4 PARTICIPANT REGISTRATION FORM & MEDICAL RELEASE (Youth & Adult) Name: Address: City/St/Zip: Phone: ( ) Birth Date: T-Shirt Size: S M L XL 2XL 3XL Grade: Adult Gender: M F Allergies or medical concerns: Medical Insurance Provider: _ Insurance Policy Number: Emergency Contact Name: Emergency Contact Number: Relationship: _ The undersigned does heartily give permission to our (my) child to attend and participate in the activities sponsored by the Jr. High DYG 2017 including swimming, recreational activities and servant events. We (I) give permission to allow any pictures or videos taken during the Pacific Southwest District of the Lutheran Church Missouri Synod to be used for publicity purposes. We (I) authorize an adult, in whose care the minor has been entrusted to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, & hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable & agrees to pay all costs & expenses incurred in connection with such medical & dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. Parent/Legal Guardian _ Date _

5 PARTICIPANT COVENANT 1. As Christians, we will treat each other with love and respect, building each other up. 2. Our leaders will be open and honest, take care of problems now, help bring people together with their struggles and be guardians of the covenant with all participants going with us to the Jr. High DYG. 3. We will ensure one another s privacy by not entering the rooms when not invited no couples alone in rooms. We will deal with problems by going to the person first, then to a friend, and then to those in authority. 4. We will obey all rules set down by the Jr. High DYG leadership: Full participation in Jr. High DYG events; lights out and quiet by 10 p.m. each night; no use of illegal drugs or alcohol; no smoking; and always travel in groups of 3 or more. 5. Anyone with a major discipline problem will be sent home at the expense of the parent, (especially drugs & alcohol). 6. We will dress in a way that is God-pleasing. I promise to live by this covenant as I experience the Jr. High DYG March Participant Signature: _ Date: _

6 EVENT REGISTRATION INSTRUCTIONS As a leader of a group considering attending the Jr. High DYG 2017, there are a few things that you should know that will help you navigate the registration process. First there are two ways in which you can register. You can register online or you can register by mail. Below you will find instructions on how to do either for of registration. Online registration process: 1. Distribute forms to youth. 2. Gather completed forms and payment from youth. 3. Go to 4. Download the Group Registration Instructions. 5. Follow the link to the registration form. 6. Pay online or by check. 7. If paying by check mail check to district office. Pacific Southwest District Attn: Dave Rueter Jr. High 1540 Concordia E Irvine, CA individual release forms & covenants to Kyle Salesky: ksalesky@abidingsavior.com 9. Reserve hotel room (details on hotel reservations at

7 FAQ s Can Our 6th Graders Attend? If your youth ministry or confirmation program includes 6th graders with your 7th & 8th please include them for the Jr. High DYG. What If A Member Of Our Group Has Special Medical Needs? If anyone in your group has special medical needs, we ask that you advise us in your registration materials, or call one of the committee members prior to the gathering so we can make proper arrangements. When Should We Arrive? Registration check-in will begin at 8:00am on Saturday, March *, No check-ins will be accepted prior to 8:00am. Groups that stayed in the hotel Friday night are encouraged to arrive only after 8:00am. Games and activities lead by the Concordia Youth Ministry Team will be available starting at 8:00am. When Do We Have Our Kids Wear Their Jr. High DYG T-Shirts? We ask that gathering shirts be worn on Saturday. Group leaders will receive their shirts at registration and are asked to distribute them to their group to wear that morning prior to the Opening Mass Event. Can Our Confirmation Class Have A Time To Meet Together? Yes! You can choose to not attend a breakout session or use the open time in the schedule prior to dinner. If you desire a room to meet in please let us know prior to the event. Is there program time for church groups to meet together? Yes! Both before and after dinner on Saturday, time as been set aside for either free time or a time for your group to meet together. You can use discussion questions we will provide or use your own. Groups interested in a room should contact Dave Rueter (david.rueter@psd-lcms.org). What Should Our Youth Pack? - Bible - Clothes for 2 days: socks, underwear, jacket or sweatshirt (for evenings or in case of rain), shorts or long pants, t-shirt, and shoes. - General toiletries: deodorant, toothpaste, toothbrush, etc. & sunscreen - Do not bring: CD players, IPODS, MP3 players, alcohol, tobacco, drugs, or weapons (including pocket knives). *Make sure ALL medication is placed in zip-lock bag with specific instructions. Leave all prescription medication in original container. Be advised groups not staying Friday night will not be able to check into the hotel until afternoon (a group leader may check in during breakout session time) or evening.

8 MAIN SPEAKER INFORMATION Main Speaker We are excited to have Professor Tom Park as our speaker at this year s Jr. High DYG. Pastor Park teaches theology at Concordia University Irvine having just joined the faculty having served as an LCMS pastor in Minnesota. Pastor Park has a passion for life and for proclaiming the Gospel to all ages. He especially enjoys teaching youth and is a true child at heart. Noted for his bow ties and impersonating a student on his first day as a professor, you never quite know just what might get from him. Pastor Park will be helping us gain a richer understanding of the work of the Holy Spirit in awakening faith in the disciples on Pentecost and launching the birth of the church. Concordia University Irvine 1530 Concordia W Irvine, CA Location Info Park in the Main Parking Lot. If you need bus parking please contact david.rueter@psd-lcms.org. Registration check-in will be by the CU Center (9 on the campus map). For directions and a campus map go to: