KINGS DOMINION 2026 – St. Luke Catholic Church

St. Luke is taking a group of high school teens to KINGS DOMINION on Friday, August 21! We’ll start the day with the 9am Mass at St. Luke and then travel to the park for a day of fun. We will return to St. Luke by around 10:00pm for pickup.

St. Luke will do a bulk ticket order for who registers – register and pay below for our discounted ticket price. Teens are responsible for bringing money for food / whatever other purchases they want to make at the park. Meal plans save a lot of money so I highly recommend purchasing one ahead of time – see below for links to details on KD’s website.

Reach out to Benj at bemrich@saintlukemclean.org if you have any questions!

*$20 per ticket, and please bring money for food, or purchase a meal plan (highly recommended) by following the link below! See the bottom of the page for how to pay online!*

Teen's Name

First

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone #

Phone & Birth

Grade for 2026-27 Academic Year

School for 2026-27 Academic Year

Known Allergies, Allergies to Medication(s), or Medical Conditions that May Affect Your Ability to Participate

Parent / Legal Guardian #1 Name

First

Last

Parent / Legal Guardian #1 Address

Parent / Legal Guardian #1 Phone

Parent / Legal Guardian #1 Email

Parent / Legal Guardian #2 Name

First

Last

Parent / Legal Guardian #2 Address

Parent / Legal Guardian #2 Phone

Parent / Legal Guardian #2 Email

Emergency Contact #1 Name, Relationship, & Phone Number

Emergency Contact #2 Name, Relationship, & Phone Number

Parent Permission Agreement

As parent/legal guardian of the youth named on this form, I give my permission to participate fully in St. Luke's KINGS DOMINION 2026 trip on Friday, August 21, 2026 from 9am-10pm. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge Bishop of the Catholic Diocese of Arlington and his successors in office, as well as the Catholic Diocese of Arlington and all Diocesan clergy, employees, volunteers, and participating parishes and schools from any and all liability, claims, demands for personal injury, sickness and death, as well as property damage and expenses of any nature whatsoever which may be incurred by the undersigned of the participant resulting from said participant’s involvement in the above mentioned event (including transportation to and from the event). Furthermore, I on behalf of the participant hereby assume all risk of personal injury, sickness, death, damage, and expenses resulting from said participant’s involvement in the above described event.

Informed Consent to Medical Treatment

I request that in my absence the above-named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor. I assume full responsibility for all costs of such treatment. Further, should it be necessary for the participant to return home due to medical, disciplinary, or other reasons, I do hereby assume responsibility for the participant’s transportation home and any costs related thereto.

Photo, Press, Audio, and Electronic Media Release

I authorize the Catholic Diocese of Arlington, its parishes, its schools and/or the Arlington Catholic Herald to use and publish my child’s photograph, video and/or audio recording along with their name identifying them for educational, news stories, illustration and/or marketing purposes. Use of electronic communication: I authorize St. Luke’s Youth Ministry and its Volunteers to communicate with the participant through the following electronic means: phone call, email, text messaging, Facebook, and Instagram. This permission is granted with the understanding that communication will take place at reasonable times and in limited durations. Parents/guardians who do not wish to grant this permission should notify St. Luke’s Office of Youth Ministry in writing.

Acknowledgment

I understand and hereby agree to the terms and conditions of the participant’s involvement in the above described event and I freely execute this Acknowledgement with full knowledge of its content.

Parent / Legal Guardian E-Signature

First

Last

By typing my full legal name in this field, and submitting this form, I affirm that I am the parent or legal guardian of the participant named above. I have read and agree to the permissions, releases, acknowledgments, and policies contained in this registration form. I understand and agree that my typed name constitutes my electronic signature and has the same force and effect as my handwritten signature.

Online Payment

Follow the link below to pay the $20.00 ticket fee online via ParishSOFT. When submitting the payment, please choose the Youth Ministry Registration option. If you have any questions, please contact me at bemrich@saintlukemclean.org or at (703) 356-3092. Thank you!

*Non St. Luke registered parishioners ,please pay via check made out to “St. Luke Catholic Church”

SAINT LUKE
CATHOLIC
CHURCH

SAINT LUKE
CATHOLIC
CHURCH

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SAINT LUKE
CATHOLIC
CHURCH