Registration

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Registration Form

This form MUST be filled out completely and signed in order to participate in the Rally. Thank you.
ByzanTEEN Rally 2022 participant must be age 13 by November 1, 2022 and not have reached the age of 18 by July 10, 2022.

Note: Those teens who were 18 last year and planned to attend the cancelled 2020 San Diego Rally and the 2021 Rally will be allowed to attend the Rally in 2022. Guidelines will be provided for these attendees on the Rally Website.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Age REQUIRED Please fill out this field. Please enter an integer (number).
Birthdate REQUIRED Please fill out this field. Please enter a date.
Grade Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Parent/Guardian Name(s) REQUIRED Please fill out this field.
Parish Name/City & State Please enter valid data.
Confidential Medical History And Authorization Form

This form MUST be filled out completely and signed in order to participate in the Rally.
Thank you.Information on this form is confidential.

In case of an emergency, please notify:
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Family Physician REQUIRED Please fill out this field. Please enter valid data.
Family Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Dentist REQUIRED Please fill out this field. Please enter valid data.
Dentist's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Health Insurance Information: Please include a copy (front and back) of your medical insurance card, prescription card and dental card. These are required if emergency care is needed.

If your child should require emergency medical attention and we are unable to reach you or any other authorized party, this form authorizes the Rally Staff to obtain medical treatment for your child. It must be signed and dated by the parent/legal guardian and sent in with the registration.

Please fill this form out COMPLETELY so your child can be treated properly.

(1) Medical History
ADD/ADHD yes no
Allergies *If yes complete also (2) below. yes no
Asthma yes no
Bleeding/Clotting Disorder yes no
Convulsions yes no
Diabetes yes no
Emotional Disorder yes no
Heart Disease yes no
Migraines yes no
High Blood Pressure yes no
Low Blood Sugar yes no
Mental Disability yes no
Physical Disability yes no
Other: Please enter valid data.
If “yes” to any of the above, please give any special information here:
(2) Allergies (please circle yes/no):
Penicillin or Other Antibiotics/Medications yes no
If yes please specify: Please enter valid data.
Insect Bites/Stings yes no
Environmental yes no
Dietary yes no
If yes check all that apply: Gluten Tree Nuts Peanuts Soy Lactose Intolerant Shellfish
Other (specify): Please enter valid data.
Is an epipen required to be carried? yes no
If “yes” to any of the above, please explain the reaction: Please enter valid data.
(3) Medications

Please list all medications to be taken (including inhalers and non-prescription medications). Medications brought must be in the original prescription packaging and dispensed by health personnel. ALL medications, including over-the-counter medications must be turned in to the health personnel.
List all medications:
The following over-the-counter medications will be available during the Rally if necessary or if requested. These medications will be administered under the direction of the health personnel. Dosages will be as listed on labels and generic equivalents will be used if available. Please circle YES if you approve using or NO if you do not wish the medication to be used:
Tylenol yes no
Advil yes no
Motrin yes no
Benadryl yes no
Tums yes no
Pepto-Bismol yes no
Maalox yes no
Immodium yes no
Topical antibiotic ointment yes no
Blood type (if known): Please enter valid data.
Please specify any activities that your child should NOT be allowed to participate in for health reasons:
Request for roommate or any additional information:
Travel Information Form

This form MUST be filled out completely and signed in order to participate in the Rally.

ByzanTEEN Rally 2022 will be held at MOUNT ST. MARY’S UNIVERSITY 16300 Old Emmitsburg Road, Emmitsburg, MD 21727.

For those driving you can get directions and maps by visiting https://msmary.edu/

For those flying in, Baltimore/Washington International (BWI) is the closest large airport and Harrisburg, PA, is the closest smaller airport. You must arrange your own transportation to and from the airport and Rally site (Mt St Mary University) on your arrival and departure dates. Travel Time by bus between BWI and the University is about 90 minutes.

ARRIVAL AND REGISTRATION TIME ON THURSDAY: 3 PM-5 PM

RALLY CLOSING AND DEPARTURE TIME ON SUNDAY: 11 AM
I will be traveling to and from the Rally by: Personal Auto Charter Bus Airline
If by Charter Bus, which parish/eparchy group are you traveling with? Please enter valid data.
Name of Group Leader/Travel Chaperone: Please enter valid data.
Contact Number of Group Leader Maximum 20 characters Please enter a phone number.
If by Airline, which parish/eparchy group are you traveling with? Please enter valid data.
Name of Group Leader/Travel Chaperone: Please enter valid data.
Contact Number of Group Leader Maximum 20 characters Please enter a phone number.
Airline and Flight Information:
Remembering Our Loved Ones At The Rally

Saint Paul tells us that Faith without good works is dead. The Church provides us with ways to perform good works. These are called the Corporal Works of Mercy and the Spiritual Works of Mercy. One of the Spiritual Works of Mercy is to Pray for the Living. During the Rally, you will have an opportunity to pray for your family and loved ones. Please list the names of your family and loved ones here and return this form with your Rally Application.
Names:
Remembering Our Departed Loved Ones

Saint Paul tells us that Faith without good works is dead. The Church provides us with ways to perform good works. These are called the Corporal Works of Mercy and the Spiritual Works of Mercy. One of the Spiritual Works of Mercy is to Pray for the Living. During the Rally, you will have an opportunity to pray for your family and loved ones. Please list the names of your family and loved ones here and return this form with your Rally Application.
Names:

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Registration

Registration Form

Confidential Medical History And Authorization Form

(1) Medical History

(2) Allergies (please circle yes/no):

(3) Medications

Travel Information Form

Remembering Our Loved Ones At The Rally

Remembering Our Departed Loved Ones