TJUC registration deadline is 10/7/11. Please submit forms and fees to DRE Barb.

1. CONtagious 2011
Heartland District's 5th Annual
YRUU Kickoff Con!
Get excited about the DYSC conference season at
CONtagious with...
CON BANDS - Small assigned groups designed to help
newcomers and old comers alike get to know people
WORKSHOPS - Play games, watch and discuss movies, learn
about social justice, and much more
CAUGHY HAUS - A goofy talent show where youth and
adults present their wacky and amazing talents
WHEN:
October 21-23, 2011
WHERE:
Unitarian Universalist Church of Indianapolis
615 West 43rd St., Indianapolis, IN 46208
www.UUI.org
WHO:
Senior High Youth (9-12th grade) and their advisors
Check-in starts at 7:00pm on Friday
TJUC REGISTRATION IS TO DRE; DEADLINE- OCOTBER 7TH
Fee: $40.00
PLEASE PAY FEE BY CHECK MADE OUT TO HEARTLAND DISTRICT
Email your questions or concerns to:
Will Taylor will.taylor@insightbb.com
or Karalyn Grimes at karalyngrms@gmail.com
IF YOU REGISTER ONLINE AND PAY BY CREDIT CARD,
PLEASE PRINT A COPY OF YOUR REGISTRATION AND PAYMENT
Register online & pay by credit card at:
http://www.heartlanduu.org/conferences_workshops.html

2. CONtagious
REGISTRATION FORM
OCTOBER 21-23, 2011
Senior High Youth and Adult Youth Advisors must complete and submit the form below to register for all
youth conferences in the Heartland District.
Registration Type (circle one): youth adult staff
Grade Level: ___________
Age: ________ Birth Date (mm/dd/yy): ___/___/________
First Name: ____________________________Last Name: ______________________________
Address: ______________________________________________________________________
City: ______________________________________St: ________Zip: _____________________
Name of parent/guardian at this address: ____________________________________________
Phone #: (____) _______-_______________Email: ____________________________________
Congregation/Church/Fellowship: __________________________________________________
Dietary Preference (circle one): omnivore vegetarian vegan
# of Cons Attended (circle one): 1 2 3 4 5 6 7 8 9 10+
I am interested in receiving a scholarship (circle one): YES NO
Registration Fee Paid: $_________
How will fee be paid (circle one): check by mail online with credit card staff-not applicable
I have read the Conference Rules and Code of Ethics/Conduct (circle one): YES NO
Date submitted: _________________________
PLEASE COMPLETE THE YOUTH PERMISSION AND HEALTH FORMS BELOW AND GIVE TO
REGISTRAR WHEN CHECKING INTO THE CONFERENCE.

3. CONTAGIOUS
PERMISSION & SUPERVISION FORM
OCTOBER 21-23, 2011
(Please complete and present form to registrar when signing in at the conference.)
Date: ___________________________
Attendee Name: ____________________________________________________________
Congregation: ____________________________________________________________
YOUTH: List adult sponsor(s) attending from your church:
1.___________________________________________2.__________________________________________
3.___________________________________________4.__________________________________________
I have read and will uphold the Youth Conference Rules. If I do not follow these rules, I may be expelled from the
conference.
Signature: ___________________________________________ Date: _________________
PARENT/GUARDIAN: In the event that my child is asked to leave the conference, I accept all responsibility for the
safe removal of my child. My child has my permission to ride to and from the conference with the following
persons:
1.___________________________________________2.__________________________________________
Signature: ___________________________________________ Date: _________________
ADULT SPONSORS: I have read and will uphold the Youth Conference Rules. If I do not follow these rules, I may
be expelled from the conference.
Signature: ___________________________________________ Date: _________________
List the names of youth under your supervision while attending this Conference:
1.___________________________________________2.__________________________________________
3.___________________________________________4.__________________________________________
5.___________________________________________6.__________________________________________
7.___________________________________________8.__________________________________________
9.__________________________________________10.__________________________________________

4. Youth Conference Rules and Code of Ethics
(Must be read and signed by all Adult Sponsors and Older Youth in Leadership Roles)
Rules: All rules apply equally to youth and adults. All rules were formed by the DYSC for liability reasons and
conferee safety. Enforcement of the conference rules is the responsibility of EVERY conferee with overall
supervision by the DYSC officers. Adults in general are not expected to be the primary rule enforcers, but are
expected to be full conference participants. Adults and youth leaders are expected to serve as good role models
and to have a signed code of ethics when they check in at conferences.
At least 1 adult per 10 youth from each church must be present (1-7
Attendees will remain on site at all times
for Jr. High events)
Being outside designated areas at any time is Illegal use of alcoholic beverages, illegal drugs and weapons are
prohibited prohibited
NO SEX! Everyone must attend all mandatory planned activities
Caffeine pills and other unnecessary drugs (Sleeping area rules would go here, but we don’t intend on
are not allowed sleeping!)
Smoking is not condoned during the Sexual behavior which detracts from the conference community
conference for youth or adults will not be tolerated
Adhere to site rules Cars are off limits during the con except for approved con business
In the event of a rules infraction, the Conference Rules Committee will be convened to determine the
consequences of the rule infraction.
Code of Ethics for Adults, Older Youth and Youth in Leadership Roles with Youth
Based on the Code of Ethics for Adults, Older Youth, and Youth who are in leadership roles with Children and
Youth, adopted by the Unitarian Universalist Association in 1986.
Adults, older youth, and youth who are in leadership roles are in a position of stewardship and play a key role in
fostering the spiritual development of both individuals and the community. It is therefore especially important
that those in leadership positions be well qualified to provide the special nurturing, care and support that will
enable youth to develop a positive sense of self and a spirit of independence and responsibility. The relationship
between young people and their leaders must be one of mutual respect if the positive potential of their
relationship is to be realized. There are no more important areas of growth than those of self-worth and the
development of a healthy identity as a sexual being. Adults play a key role in assisting youth in these areas of
growth. Wisdom dictates that youth and adults suffer damaging effects when leaders become sexually involved
with young persons in their care; leaders will therefore refrain from engaging in sexual, seductive or erotic
behavior with youth. Neither shall they sexually harass youth nor engage in behavior with youth that constitutes
verbal, emotional or physical abuse. I, _______________________________________, as a youth leader, an older
youth (over 18) or an adult, recognize my position of power and have read and understand the above statements
of position, expectations and actions and agree to follow the Code of Ethics.
**Signature: __________________________________________________Date:___________

5. CONtagious
EMERGENCY FORM
OCTOBER 21-23, 2011
(To be filled out by all Conference Attendees)
Attendee’s Name: _________________________________________________________________
Name of Parent(s)/Guardian(s): _______________________________________________________
Parent(s)/Guardian(s) Phone # (____) _____________________
Physician: ____________________________________ Phone #: (_____) _____________________
Insurance Company: _______________________________________________________________
Policy Holder: __________________________________ Policy #: ____________________________
Allergies: ______________________________________________________________________
Health Conditions: ________________________________________________________________
Please list any medications you are taking (and reason):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please list two people, other than parents, that we can contact in an emergency who can legally provide
authorization for medical treatment.
Name: _____________________________________________ Phone: (____) __________________
Name: _____________________________________________ Phone: (____) __________________
Please check one of the following and sign:
_____I Request Medical Treatment for my child without prior notification.
_____I Request NO Medical Treatment for my child without prior notification.
In the event of an emergency, I understand that the DYSC/Heartland District will try to contact me. If I am unable
to be reached, the DYSC/Heartland District will do their best to ensure the safety and health of my child,
__________________________________________________________________.
(Insert child’s name)
I do not hold the District Youth Steering Committee, the Heartland District, or the host church liable in the event
of an emergency.
Signature of Parent/Guardian: ______________________________________ Date: ____________________