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St. Juan Diego Parish Archdiocese of Portland in Oregon Fifth Sunday of Easter April 28, 2013 That is the message we hear in today’s gospel. That is the message we are seeing and hearing from Pope Francis. So how are we showing our love? Today we celebrate First Eucharist with the children and the families who have been preparing for this sacrament all year. This is the Sacrament of Love, the sacrament that shows how much God indeed loves us; he gave us his only begotten son. That Jesus was crucified, died and rose again must be seen as the greatest act of love. Then to see these children receive Jesus for the first time, shows us how we are to love Jesus, as these children love Jesus. Simply by receiving him, we are witnessing to our faith. Even at the young age of 7 or 8 these children are evangelizing. We spend much effort and time helping these children to learn and understand what it means to receive the body and blood of Christ. But even more will come to believe by seeing the witness of these children, seeing how reverent and joyful they are to be followers of Jesus and to receive him in the Most Holy Eucharist. Pope Paul VI wrote, "Modern man listens more willingly to witnesses than to teachers, and if he does listen to teachers, it is because they are witnesses."[EVANGELII NUNTIANDI, 41] I believe that is what the New Evangelization is about… being good witnesses. Archbishop Alexander Sample emphasized in his homily reflecting on the New Evangelization at the Pastoral Ministry Conference two weeks ago, “It starts with me” he repeatedly said. How do we live lives of evangelization? How do we witness to our faith? How do we show Christ’s love to one another? I particularly like one of the new options for the final dismissal “Go in peace, glorifying the Lord by your life.” When we receive Jesus in the Eucharist each week we are then sent out on the mission that Christ gave us that demands a true witness of the Gospel - to “love one another”. When you see the love these children have for Jesus in the Eucharist, I hope it will inspire all of us to share in that joy and love by living a life of love in Christ Jesus. In Christ’s Love, Bridget Becker Director of Faith Formation Love One Another Prayer Intentions For those who are ill: For those who are ill: For those who are ill: For those who are ill: Kristi Claeys, daughter of Don & Ardith Claeys Bob & Betty Curl Barbara Connor Dottie & Al Faiman, parents of Joan Eisenbach Ralph McLenithan Theresa Pham, sister of Van Funk Theresa Vu, niece of Van Funk Wallace D. Kling, father of Dean Kling For those who have died: For those who have died: For those who have died: For those who have died: Astrid Griffin-O'Hara, aunt of Julie Moraes Congratulations to those who received their First Eucharist today! Trevor Beale Luke Carlson Andrew Catron James Clark Peter Cook Allison Dillenberg Jamie Dillon Christopher Ernst Peter Fornia Isabella Fuentes Catherine Gibson Alexander Hart Thomas Huelskamp Sam Jamieson Savanna Kleine Alyssa Larson Emme T Luong Liana McKeen Antonio Mesa Angela Miller Caroline Molamphy Skye Monchilovich Matthew Moraes Maggie Nichols Sophie Olson Evan Petrie Andrew Robinson Olivia Robinson Noah Shea Stefany Soto Colin Taylor Danny Wagnon Aiden Worth

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Page 1: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

St. Juan Diego Parish

Archdiocese of Portland in Oregon

Fifth Sunday of Easter April 28, 2013

That is the message we hear in today’s gospel. That is the message we are seeing and hearing from Pope Francis. So how are we showing our love? Today we celebrate First Eucharist with the children and the families who have been preparing for this sacrament all year. This is the Sacrament of Love, the sacrament that shows how much God indeed loves us; he gave us his only begotten son. That Jesus was crucified, died and rose again must be seen as the greatest act of love. Then to see these children receive Jesus for the first time, shows us how we are to love Jesus, as these children love Jesus. Simply by receiving him, we are witnessing to our faith. Even at the young age of 7 or 8 these children are evangelizing. We spend much effort and time helping these children to learn and understand what it means to receive the body and blood of Christ. But even more will come to believe by seeing the witness of these children, seeing how reverent and joyful they are to be followers of Jesus and to receive him in the Most Holy Eucharist. Pope Paul VI wrote, "Modern man listens more willingly to witnesses than to teachers, and if he does listen to

teachers, it is because they are witnesses."[EVANGELII NUNTIANDI, 41] I believe that is what the New Evangelization is about… being good witnesses. Archbishop Alexander Sample emphasized in his homily reflecting on the New Evangelization at the Pastoral Ministry Conference two weeks ago, “It starts with me” he repeatedly said. How do we live lives of evangelization? How do we witness to our faith? How do we show Christ’s love to one another? I particularly like one of the new options for the final dismissal “Go in peace, glorifying the Lord by your life.” When we receive Jesus in the Eucharist each week we are then sent out on the mission that Christ gave us that demands a true witness of the Gospel - to “love one another”. When you see the love these children have for Jesus in the Eucharist, I hope it will inspire all of us to share in that joy and love by living a life of love in Christ Jesus.

In Christ’s Love, Bridget Becker

Director of Faith Formation

Love One Another

Prayer Intentions

For those who are ill:For those who are ill:For those who are ill:For those who are ill:

Kristi Claeys, daughter of Don & Ardith Claeys

Bob & Betty Curl Barbara Connor

Dottie & Al Faiman, parents of Joan Eisenbach

Ralph McLenithan

Theresa Pham, sister of Van Funk

Theresa Vu, niece of Van Funk

Wallace D. Kling, father of Dean Kling

For those who have died:For those who have died:For those who have died:For those who have died:

Astrid Griffin-O'Hara,

aunt of Julie Moraes

Congratulations to those who received their First Eucharist today!

Trevor Beale

Luke Carlson

Andrew Catron

James Clark

Peter Cook

Allison Dillenberg

Jamie Dillon

Christopher Ernst

Peter Fornia

Isabella Fuentes

Catherine Gibson

Alexander Hart

Thomas Huelskamp

Sam Jamieson

Savanna Kleine

Alyssa Larson

Emme T Luong

Liana McKeen

Antonio Mesa

Angela Miller

Caroline Molamphy

Skye Monchilovich

Matthew Moraes

Maggie Nichols

Sophie Olson

Evan Petrie

Andrew Robinson

Olivia Robinson

Noah Shea

Stefany Soto

Colin Taylor

Danny Wagnon

Aiden Worth

Page 2: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

Crisis Prayer Chain: www.stjuandiego.org/crisisprayerchain.htm

St. Vincent de Paul Food Pantry: 503-985-6046 Mon: 4:00pm - 5:30pm / Thu: 10:00am-12:00pm / Fri: 11:00am-1:00pm

Fr. Ted Frison……………………. Parish Priest

Phone: 503-644-1617 Email: [email protected]

Rev. Mr. John Riherd……………. Deacon

Email: [email protected]

Rev. Mr. Dennis Desmarais……... Deacon

Email: [email protected]

Bridget Becker…………………... Director of Faith Formation

Email: [email protected]

Phone: 503-610-3644

Peggy Brice……………………… Business Manager

Email: [email protected]

Priscilla Goodman……………….. Administrative Assistant, Bulletin

Email: [email protected]

Janette Smith…………………….. Liturgy & Music Coordinator

Email: [email protected]

Staff

Scripture Readings

Saturday Evening Mass: 5:00 pm Sunday Morning Mass: 9:00 am and 11:45 am

Sacrament of Reconciliation: Saturdays 4:00-4:30 pm Weekday Mass: Wednesday–Saturday 8:00 am

Holy Day Masses: Call for schedule 503-644-1617

To have a Mass offered for anyone, call or email Priscilla Goodman at the office. Suggested donation $10.

Mass Schedule and Intentions

Office: 5995 NW 178th Ave., Portland, OR 97229

Phone: 503-644-1617 503-726-1657 (call to fax)

Office Hours: Tuesday - Friday, 9:00am to 4:00pm Web site: www.stjuandiego.org

St. Juan Diego Catholic Church

April 28

Fifth Sunday

of Easter

May 5 Sixth Sunday

of Easter

First Reading Acts 14:21-27 Acts 15:1-2,22-29

Second Reading Revelation 21:1-5a Revelation 21:10-14,22-23

Gospel John 13:31-33a,34-35 John 14:23-29

Thank you for your generous support of our Parish

Apr 29 Mon No AM Mass

Apr 30 Tue No AM Mass

May 1 Wed 8:00 am Dao Nguyen (ill)

May 2 Thu 8:00 am � Geneva Korol by Ed and Karolina Kolinski

May 3 Fri 8:00 am Open Intention

May 4 Sat 8:00 am � All Souls by Julie Huynh

5:00 pm Open Intention

May 5 Sun 9:00 am Mass for the People

11:45 Open Intention

SANCTITY OF LIFE

Mutually Exclusive Categories? "Pope Francis presents a peculiar problem for the modern world. On the one hand, he is well-known for his concern for the poor and his strong commitment to Social Justice. On the other, he unequivocally opposes abortion. By virtue of the former commitment he qualifies as a “liberal.” But his opposition to abortion would make him eligible for the label “conservative.” How is it possible for one man to embody two seemingly mutually exclusive categories? Is this a conundrum or simply a matter of being consistently Catholic? Catholicism, because it does not place people in classes, extends its concern to everyone, the poor, the “unfit,” the weak, and the unborn alike. Therefore, it is perfectly normal for a Catholic to work for social justice and defend the right-to-life of the unborn. As Cardinal Ratzinger has said, “Love of neighbor knows no limits . . . There is no gap between love of neighbor and desire for justice.” Pope Francis, therefore, is not a conundrum, but a Catholic. ... Pope Francis may convince many by his words and his example that Catholicism and politics are not the same, and that God’s abiding love extends to all of his human creatures. Social justice and defense of the unborn, therefore, are unitary." (http://www.truthandcharityforum.org/neither-conservative-

nor-liberal-solving-the-conundrum/) Dr. Donald DeMarco,

Senior Fellow of Human Life International

April 20/21 ….. 618 People

Collection Basket ….. $ 3,317.25

Electronically or by mail ….. $ 4,374.33

SOCIAL JUSTICE

May 1 is International Worker’s Day and the Feast of St.

Joseph the Worker. Read the recently released “Background on Protecting the Rights of Workers in a Globalized Economy” from the United States Conference of Catholic Bishops. http://www.usccb.org/issues-and-

action/human-life-and-dignity/labor-

employment/upload/2013-02-Rights-of-Workers-

Backgrounder.pdf

The world is only a few cases away from killing polio forever. Help make it happen by signing The End of

Polio Petition calling on world leaders to finish the job by making funding commitments that will see a polio-free world.” Get information at: http://www.one.org/international/blog/the-world-is-only-a-

few-cases-away-from-killing-polio-forever/ and sign the peti-

tion athttp://www.theendofpolio.com/home/

The Union of Concerned Scientists puts rigorous, independent science to work to solve our planet's most pressing problems. Joining with citizens across the country, we combine technical analysis and effective advocacy to cre-ate innovative, practical solutions for a healthy, safe, and sustainable future. http://www.ucsusa.org/about/

Take action at http://www.ucsusa.org/action/

Page 3: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

Mark your Calendars For Summer fun!

Camp Howard July 21-26, Camp info available in the Narthex.

VBS 2013 August 5-9, from 9am – Noon.

If you would like to help with planning please contact Bridget

[email protected]

Blood Drive St. Juan Diego Church

Monday, May 6, 2013

3:00 PM- 8:00 PM To schedule your appointment,

please sign up in the Narthex.

You can also call

1-800-RED CROSS (1-800-733-2767)

or go online www.redcrossblood.org;

sponsor code:StJuanDiegoPDX

AROUND THE ARCHDIOCESE Jesuit Volunteer EnCorps (JVE) is a faith-based volunteer program of JVC Northwest designed for people 50 and older. During their ten months of volunteer service, they meet together regularly in community, deepen their spirituality, and explore the value of simple living. Applications now available. For more information, call us at (503) 335-8202 or visit http://jvcnorthwest.org/get-involved/joining-jvc-encorps/ 24th Annual Tobin Lecture - St. Francis,

Pope Francis, and a Vision for the 21st

Century Parish Wednesday, May 15 from 6:30 pm to 9:00 pm. All Saints Catholic Church, 3847 NE Glisan Avenue, Portland. Keynote Speaker: Jack Jezreel, founder of the JustFaith Program; Execu-tive Director of JustFaith Ministries. The Adapted Liturgy, May 26. This is a Mass that celebrates the lives and gifts of all people, including those with physical and developmental disabilities and illnesses. It is offered the 4th Sunday of every month at 2:45 pm at St. Pius X, 1280 NW Saltzman Rd, Portland, OR; call 503-644-5264 . Every effort is made to accommodate the inclusion and participation of each person. . Future dates are June 23, July 28, and August 25. A casual reception follows. All are welcome to this joyful gathering!

Catholic Home

Missions Appeal Strengthening the Church at Home

Many dioceses right here in the United

States do no have enough priests and

trained lay ministers to serve their

parishes. These dioceses are known as

home missions. The Catholic Home

Missions Appeal supports these

dioceses by funding essential ministries,

including seminary education and lay

ministry training. Please be generous in

this Appeal and help strengthen the

Church at home.

Battery recycling is no longer available in the Narthex. Due to the volatility of batteries stored for recycling we will no longer be able to accept batteries. Metro sponsors Household Hazardous Waste Collection Events every weekend from March to November. Here is a link to their schedule: http://www.oregonmetro.gov/index.cfm/go/by.web/id=26580

Calling ALL SJD 5th - 8th graders!

WHAT: Join us for a night of dinner and fun! WHERE: John’s Incredible Pizza 9180 SW Hall Boulevard WHEN: Friday, May 3, 7-9:30pm WHY: To celebrate the outgoing 8th graders and incoming 5th graders! BRING: $15. This will get you a full dinner, unlimited beverages, 60 Fun World credits ($15.00 Value), 50 free redemption tickets and 2 rides of your choice. RSVP: Email Angela Highfill-Enriquez, [email protected] or text her at 971-226-5970. Family members are welcome! Please RSVP! We need to make reservations and put down deposits for our event, and need an accurate head count. Thanks! Don’t forget to bring a completed permission slip available in the Nar-thex. Additional questions? Contact Angela!

Faith Formation

2012 –2013 Schedule

Last Class with Ice Cream Party: May 5 during class. We will gather for short presentations in the auditorium, Room 128, then enjoy some ice cream and fellowship to celebrate the end of

another fun and faith filled year!

Registration forms for next Fall are available at church or on the parish

|website. www.stjuandiego.org/

dfaithformation.htm

Eucharistic

Adoration:

May 3 from

7 pm to 10 pm “Can you watch one hour

with me?” (Matthew 26:40)

We invite you to take time for quiet reflection this

Easter season. Our Lord is truly present in the Blessed Sacrament and is to be adored. Come for an hour or a shorter visit, alone, or with your family members, to offer prayers and to be re-freshed in the powerful presence of Je-

sus~He will change your life!

Sound System Capital Improvement Second Collection will be next weekend. The money raised from this campaign will implement permanent elements of the sound system designed for our unique space. The cost of this project is $53,000 but thanks to a matching donation of $25,000, the goal of this campaign is $28,000. Make checks out to St. Juan Diego Church and put ‘Sound System campaign’ in the memo line. Please generously support this urgently needed

Page 4: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

We have an opportunity to make an

URGENTLY needed permanent

improvement to our church.

A generous donor has come forward with a matching

donation to improve our sound system.

Our current configuration is not what Tobin Cooley,

president and senior acoustical engineer of Listen

Acoustics, designed for our church. The equipment

we have is from the churchnasium. The sound

bounces around creating “dead spots” where sound is completely lost.

The new speaker setup will direct sound from overhead and new construction diffusion

panels will greatly improve the acoustics of our unique church design.

(See back for new configuration)

We can put a system in place which is a permanent improvement specifically designed

for our church and aligned with its future architectural growth.

Best of all we’ll be able to fully appreciate the spoken Word and the beautiful music of

our choir.

What is this campaign about?

What is the cost?

Total Cost of the Project: $53,000

Matching Donation: $25,000

Campaign Goal: $28,000

How can I help make this happen?

There will be a second collection on May 4 & 5. Additionally, drop off your donation or

mail it to the Parish Office. For this campaign, all funding needs to be received

before the improvements can be made. Thank you for your generous support of

our parish and this urgent improvement!

We have heard your concerns!

Sound System Capital Improvement Campaign

Page 5: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

St. Juan Diego Sound System Capital Project

Sound Diffusion Wall Panels

Sound Diffusion Wall Panels

5 Overhead Mounted Speakers

Sound Processor and Amplifier

Priscilla
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Dimensions not to scale
Page 6: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

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Page 7: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

5995 NW 178th Ave, Portland, OR 97229

503.644.1617 503.726.1657 (fax) Call first

Office Hours: Tuesday to Friday, 9:00 AM to 4:00 PM

Mass Schedule

Saturday Vigil Mass

5:00 PM

Sunday Masses 9:00 AM with Children’s Liturgy of the Word

11:45 AM

Sacrament of Reconciliation

4:00 - 4:30 PM Saturday

Weekday Masses 8:00 AM Wednesday to Saturday

Holy Day Mass: call the office for schedule.

Office and Staff

Web site: www.stjuandiego.org

Fr. Ted Frison, Parish Priest, tfrison(at)archdpdx.org

Rev. Mr. John Riherd, Deacon: jriherd(at)archdpdx.org

Rev. Mr. Dennis Desmarais, Deacon: desmarais5(at)comcast.net

Bridget Becker, Director of Faith Formation: bbecker(at)stjuandiego.org

Faith Formation Message Phone: 503.610.3644

Peggy Brice, Business Manager: pbrice(at)stjuandiego.org

Priscilla Goodman, Administrative Assistant: pgoodman(at)stjuandiego.org

Janette Smith, Liturgy & Music Coord: jcsmith(at)stjuandiego.org

St. Vincent de Paul Food Pantry: 503.985.6046

Hours: Monday 4:00-5:30 PM, Thursday 10:00 AM-Noon,

Friday 11:00 AM -1:00 PM

Parish Ministries

Pastoral Council: Chair, Damian Brayko dbrayko(at)gmail.com, Dean Kling, Shirley

Bertram, Barb Upson, Ramata Adebawo, Jake Nofziger, Raquel Apodaca, John

Puttman, Dominic Sandri, Cliff Yee, John Richard, Fr. Ted Frison, and Bridget Becker

Admin Council: Chair Pat Kurkoski, Tom O’Donnell, Jerzy Rub, Mike Cooney,

Patti Gillette, Fr. Ted Frison, and Peggy Brice

Altar Servers: Avi Huelskamp, huelskampavi(at)yahoo.com

Baptism Prep: Bridget Becker, bbecker(at)stjuandiego.org

Bereavement: Parish Office, 503.644.1617

Bulletin Articles: Priscilla Goodman, pgoodman(at)stjuandiego.org

Bulletin Sponsors: Peggy Brice, pbrice(at)stjuandiego.org

Capital Campaign Continuation Committee: Les Fahey, faheyventures(at)earthlink.net

Children’s Liturgy of the Word: Kathy Marshall, marsh06(at)comcast.net

Children’s Choir: Aurea Taylor, aurea.taylor(at)frontier.com

Crisis Prayer Chain: www.stjuandiego.org/crisisprayerchain.htm

Eucharistic Service to the Homebound: Bridget Becker, bbecker(at)stjuandiego.org

Eucharistic Ministers: Mary Johnson, pmjonson(at)frontier.com

Faith Café: Catherine Moore, moorefun99(at)comcast.net

Faith Formation: Bridget Becker, bbecker(at)stjuandiego.org

First Eucharist and Confirmation Prep: Bridget Becker, bbecker(at)stjuandiego.org

Greeters: Debbie Wells, wdjwells(at)aol.com

Hospitality on Saturday: .Tammy Taylor, mommat503(at)gmail.com

Hospitality on Sunday: Jeanne Sabbe, jeannesabbe(at)comcast.net

Knights of Columbus: William Miller, william.miller(at)providence.org

Landscape Design Committee: Rachel Arjavac, sjdlandscape(at)gmail.com

Lectors: Dean Kling, dfkling(at)gmail.com

Liturgy Planning: Maureen Barnhart, Maureen.barnhart(at)frontier.com

Maintenance Committee: Paul Nofziger, sjdmaintenance(at)gmail.com

Marriage Prep: Parish Office, 503.644.1617 or pgoodman(at)stjuandiego.org

Mass Collection Counters: Kathy Fritz, klindsayfritz(at)hotmail.com

Music Ministry - Choir and Bell Choir: Janette Smith, jcsmith(at)stjuandiego.org

New Parishioner Welcome: Don Claeys, doncslugs(at)frontier.com

Parents and Children Ministry: Betty Tschanz, betty.tschanz(at)yahoo.com

Parish Health: Barbara Hula, 503.629.5912, barbarahula(at)gmail.com

RCIA: Bridget Becker, bbecker(at)stjuandiego.org

Sacristans: Maggie Brown, hmbrown1(at)frontier.com

SCRIP Gift Card: Lisa Anderson, [email protected]

Small Christian Community: Bridget Becker, bbecker(at)stjuandiego.org

Social Justice: Ken David, thedavidfam(at)gmail.com

St. Vincent De Paul: Bob Taylor, rgtaylor83(at)comcast.net

Vocations Committee: Sr. Charlene Herinckx, SSMO, srcharleneh(at)ssmo.org

Website: Bridget Becker, bbecker(at)stjuandiego.org

Welcome Home Catholics: Katy LaDu, katyladu(at)fibersphere.net

Worship Environment Committee: Sherry Kirkpatrick, kirksherr(at)q.com

Young Adults: Kristy Bartle, kristinmbartle(at)gmail.com

St. Juan Diego Church Archdiocese of Portland in Oregon

Updated 4/25/13

Page 8: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

Calling ALL SJD5th - 8th graders!

WHAT: Join us for a night of dinner and fun!

WHERE: John’s Incredible Pizza 9180 SW Hall Boulevard

WHEN: Friday, May 3, 7-9:30pm

WHY: To celebrate the outgoing 8th graders and incoming 5th graders!

BRING: $15. This will get you a full dinner, unlimited beverages, 60 Fun World credits ($15.00 Value), 50 free redemption tickets and 2 rides of your choice.

RSVP: Email Angela Highfi ll-Enriquez, [email protected] or text her at

971-226-5970.

Family members are welcome!

Please RSVP! We need to make reservations and put down deposits for our event, and need an accurate head count. Thanks!

Don’t forget to bring a completed permission slip, found on the reverse!

Additional questions? Contact Angela!

Page 9: Archdiocese of Portland in Oregon · 1/2/2014  · St. Juan Diego Parish Archdiocese of Portland in Oregon April 28, 2013 Fifth Sunday of Easter That is the message we hear in today’s

ARCHDIOCESE OF PORTLAND Parent / Legal Guardian Event Permission Slip

For Student / Youth

TO BE COMPLETED BY SPONSORING PARISH / SCHOOL

Below please find a brief description of the schedule of activities:

Event: Night at the Corn Maze Location: Baggenstos Farms

Archdiocesan Parish, School or Agency: St. Juan Diego

Date of Event: Friday, October 14 Departure Date: Friday, October 14

Departure Time: 6:30 pm Return Date: Friday, October 14

Estimated Time of Return: 9:00 pm Mode of Transportation: cars

TO BE COMPLETED BY PARENT / LEGAL GUARDIAN

I, _______________________________, the undersigned, give my permission for __________________ (Parent / Legal Guardian) (Son / daughter) to take part in an off-premises event which will require transportation and supervision by Archdiocesan employees and volunteers.

I agree to allow my child to participate in this event.

I agree and understand that transportation may be provided in such form and at the discretion of the Archdiocese of Portland.

I also authorize the Archdiocese of Portland and its employees or chaperones to secure any and all necessary medical services for my child in the event of an accident or illness. Further, I agree to be solely responsible for the payment of those services.

Child’s name ____________________________ Date of Birth ____________ Sex Male Female

Allergies (foods, drugs, insects, etc.) ____________________________________________________________

Medications (name, dosage, reason) ____________________________________________________________

Other information (injuries, etc.) _____________________________________________________________

Insurance Carrier __________________________________________Group and/or ID # ______________

In case of emergency, please notify:

Parent / Guardian(s) _____________________________________________________________________

Day Phone Number(s) ___________________ Evening Phone Number(s) __________________________

Child’s Doctor ________________________________ Phone Number ____________________________

____________________________________________________ ____________________________ Parent / Guardian Signature Date

THIS FORM TO BE KEPT ON FILE FOR THREE YEARS

John’s Incredible Pizza

Friday, May 3 Friday, December 7

Friday, May 3

Dinner and Fun

7:00 pm personal vehicle 9:30 pm