CONVERGE – St. Luke Catholic Church

CONVERGE is an opportunity for middle school youth (grades 6-8) to enjoy fun & games, sports, snacks, opportunities to make new Christ-Centered friendships, and a chance to grow deeper in faith.

CONVERGE will be meeting throughout the 2026-27 school year on Thursdays from 7-8:30pm at the St. Luke School Gym! (7005 Georgetown Pike, Mclean, VA 22101) We’ll be meeting on 1st, 3rd, & 5th Thursdays of each month. See our Youth Ministry Calendar for the dates.

Please consider helping us offset some of the costs of CONVERGE by providing the (optional) registration fee of $50 per participant. This greatly helps us to address some of the costs associated with the program. More details at the bottom of the page! Thanks.

*Don’t forget to join our Flocknote messaging system to get communications on upcoming Life Teen dates and other high school events! Click / tap here to sign up, it’s totally free.

Registration for CONVERGE

This form is for registration in the CONVERGE program at St. Luke Catholic Church which meets 1st, 3rd, & 5th Thursdays from 7:00-8:30pm throughout the the 2026-27 year (August 2026-August 2027). Please fill out the following form and submit. All information will be received by St. Luke Youth Ministry staff and will be kept in our databases. If you are able, please consider paying the optional $50.00 registration cost per-participant by check or electronic payment. If you wish to do payment online, please see the bottom of this page for details. The registration cost is not required, but it greatly helps our ability to continue providing quality ministry at St. Luke Catholic Church. Thank you!

*Non registered St. Luke Parishioners, please pay via check.

Teen's Name

First

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone #

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 CONVERGE program from 7:00-8:30pm on 1st, 3rd, & 5th Fridays from Aug. 20, 2026 to Aug. 19, 2027 (see calendar for specific dates). 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.

Email / to

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 Signature

Clear Signature

Online Payment

Follow the link below to pay the optional $50 registration amount online via ParishSOFT. This is an optional payment that greatly helps us to offset some of the cost of a year of CONVERGE. All payments go directly to the costs of the CONVERGE program. When submitting the payment, please choose the Youth Ministry Registration option. If you are unable to make the payment, please know that you are always welcome to attend free of charge. 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

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SAINT LUKE
CATHOLIC
CHURCH