Please                             STAFF Application                     Please

     attach                                                                                                               attach a

   a photo of                                                                                                           copy of

    yourself                                                                                                          your insurance

      here                                                                                                                 card here

                            IN Massachusetts

Please print or type:

Name: __________________________________ Grade in School: ______________ Year of Grad: _________

Address: __________________________________ City St Zip: __________________________________

Home Phone: ______________________ Cell Phone:___________________________________________

Birthdate: ____________ Age: ____ e-mail: __________________________________________________

AIM Screen name: _____________________________________________________________________

Please list any allergies or food restrictions: ___________________________________________________

Happenings attended (please list the # and your position on each weekend): ______________________________________________________________________________

Home church: ______________________City: _______________________ Priest: ___________________

Please answer the following questions; if you need more room, please write on the back of this form!

1. In what areas are you willing to serve at Happening? (Please check all that apply)

Table Leader ___Gofer ___Elf___Big Sibling____Prayer Team____Mom or Dad____Talk Giver____

2. How are you active in your church and/or in diocesan activities?

3. What does Happening mean to you?

Please remember that we read each application carefully and pray about the entire staff before choosing staff.

 You must have your parents fill out the following information and sign below.

I hereby give my child permission to attend Happening as a staff member and authorize Shaylin Walsh or any other attending adult to give medical treatment should the need arise.

Name (print): ________________________________ Signature: ___________________________________ Emergency contact phone(s): (please include your cell phone if you have one)           __________________________________________________________________

Insurance company and policy number: __________________________________________________________

Attendance at all meetings as well as the late night is required.

If accepted, staff must also pay the Happening registration fee of $110.00.

Please complete and return to:

Shaylin Walsh *103 Manomet Street * Brockton, MA 02301               www.masshappening.org