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IFTJ 2022 Delegate Registration
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IFTJ 2022 Delegate Registration
IFTJ 2022 Delegate Registration
Contact Info
Salutation
Br.
Deacon
Dr.
Fr.
Msgr.
Prof.
Rev.
Sr.
If Applicable
First Name
(Required)
Last Name
(Required)
Suffix
If Applicable
Pronouns
She/Her/Hers
He/Him/His
They/Them/Theirs
Other or Prefer not to Say
Email
(Required)
Mobile Phone
I would like to receive email updates from ISN
Yes
I would like to receive ISN Adcocacy Alert texts
Yes
I would like to receive direct mail from ISN
Yes
Permanent Mailing Address
Students: please provide a family address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Twitter handle
Only username, without "@"
Instagram user ID
Only Id, not full url (e.g. "john.doe")
Wavier
Are you older than 18?
Yes
No
Waiver
STATEMENT OF RESPONSIBILITY AND WAIVER OF RELEASE OF LIABILITY
I would like to participate in the Ignatian Family Teach-In for Justice (IFTJ) sponsored by the Ignatian Solidarity Network (ISN), taking place at The Washington Hilton in Washington, D.C. from Saturday, October 22, 2022 to Monday, October 24, 2022.
In exchange for ISN’s agreement to allow me to participate in this program, I agree as follows:
1. I understand that there are risks involved with travel and participation in this program. I understand the nature of the program and have been given the opportunity to ask questions about the program and travel to and from the program. I understand that ISN does not require me to participate, but I want to do so, despite any risks and despite this statement of responsibility, waiver, and release (“statement”).
2. In regard to COVID-19, I acknowledge and understand that participation includes possible exposure to and illness from COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist. I ASSUME ALL SUCH RISKS RELATED TO COVID-19, EVEN IF ARISING FROM THE NEGLIGENCE OF ISN, or its partners or sponsors, including the directors, officers, employees, volunteers, or agents of ISN, its partners, or sponsors. I understand that ISN has established protocols related to COVID, including but not limited to requiring documentation of a complete immunization with a vaccine approved by the U.S. Federal Government, as declared by the Center for Disease Control (CDC). I understand that I must abide by this and any other established protocols at all times and failure to do so may result in exclusion from IFTJ events. Because of the rapidly changing risk and regulatory landscape relating to the COVID-19 pandemic, these protocols are subject to change at ISN’s discretion.
3. I represent and warrant that I am and will be covered throughout the program by a policy of comprehensive health and accident insurance providing coverage for injuries and illnesses I sustain or experience abroad or during travel outside the United States. I absolve ISN from all responsibility and liability for any injuries, illnesses, claims, damages, charges, bills and/or expenses I may incur during the program, including travel to and from the program.
4. I understand that ISN reserves the right to decline to accept or retain me in the program at any time should my behavior impede program operations or the rights or welfare of any person. I understand that if I violate any ISN policy or procedure, I may be required to leave the program at the sole discretion of ISN representatives. In such an event, no refund will be made and I will bear any costs associated with the decision to require me to leave the program. If an ISN representative determines that proceeding with the program will subject participants to increased danger, I understand that ISN may, in its sole discretion, cancel the program before departure, or cancel the program after departure and will require that all participants return to their home institution. I understand that in such an event, no refund will be made and I will bear my share of any costs associated with the decision to cancel the program.
5. In exchange for the opportunity to participate, I personally assume all risks in connection with my participation in and travel to and from the program. I release ISN, its trustees, officers, agents, employees, and representatives (individually and in their official capacities) from any and all liability for any personal injury (including death) or damage to personal property (including total loss) in connection with my participation in and travel to and from the program. I agree to indemnify, defend and hold harmless ISN and/or any of those mentioned above from any and all liability, losses, damages, judgments or expenses, including attorney’s fees that they or any of them incur or sustain in connection with my participation in and travel to and from the program. I understand that this statement covers any and all claims against ISN or any of those mentioned above. I also understand that this statement binds me, my family, estate, and/or heirs.
6. I agree that this statement is to be construed under the laws of the State of Ohio and that if any portion is held to be invalid; the balance shall remain in full force and effect. I have read this statement in its entirety. I understand its terms and agree to be legally bound by it.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Signature
You will asked to complete the waiver through your delegation leader.
Your Institution
Institution Name
(Required)
I don't see my institution listed.
Academy of Notre Dame de Namur (PA)
Alpha Sigma Nu
Archbishop Mitty High School (CA)
Archbishop Williams HS
Arrupe Jesuit High School (CO)
Association of Jesuit Colleges and Universities
Augsburg University Center for Global Education and Experience
Bellarmine Chapel (OH)
Bellarmine College Preparatory (CA)
Bellarmine Prep (WA)
Bishop Chatard High School
Bishop O'Connell High School (VA)
Bishop O'Dowd High School (CA)
Bon Secours Volunteer Ministry (MD)
Boston College (MA)
Boston College High School (MA)
Boston College School of Theology and Ministry (MA)
Brebeuf Jesuit Preparatory School (IN)
Brophy College Preparatory (AZ)
Cabrini College (PA)
Canadian Jesuits International
Canisius College (NY)
Canisius High School (NY)
Canterbury School (CT)
Carondelet High School (CA)
Cathedral Catholic High School (CA)
Catholic Climate Covenant
Catholic Diocese of Cleveland, Newman Catholic Campus Ministry
Catholic Mobilizing Network to End the Use of the Death Penalty
Catholic Theological Union
Catholic Women Preach
Center for FaithJustice (NJ)
Central Catholic High School (OR)
Chestnut Hill College (PA)
Cheverus High School (ME)
Christ the King Jesuit College Prep (IL)
Christians for Peace in El Salvador (CRISPAZ)
Church of the Holy Family (VA)
College of the Holy Cross (MA)
Convent of the Sacred Heart (NY)
Creighton Preparatory School (NE)
Creighton University (NE)
Cristo Rey Atlanta Jesuit High School (GA)
Cristo Rey Brooklyn High School (NY)
Cristo Rey De La Salle (CA)
Cristo Rey Jesuit High School (IL)
Cristo Rey Jesuit High School (MD)
Cristo Rey Jesuit High School (WI)
Cristo Rey New York High School (NY)
Cristo Rey Philadelphia High School (PA)
Cristo Rey Saint Martin College Prep (IL)
Cristo Rey San José Jesuit High School (CA)
De La Salle North Catholic High School (OR)
De Smet Jesuit High School (MO)
Dominican Academy (NY)
Ethix Ventures
Fairfield College Preparatory School (CT)
Fairfield University (CT)
Farm of the Child / Finca del Nino (FL)
Fordham Preparatory School (NY)
Fordham University (NY)
Franciscan School of Theology
Georgetown Preparatory School (MD)
Georgetown University (DC)
Gesu Catholic Church (MI)
Gonzaga College High School (DC)
Gonzaga Preparatory High School (WA)
Gonzaga University (WA)
Gwynedd Mercy University (PA)
Holy Trinity Catholic Church (DC)
Jesuit Conference of Canada and the United States
Jesuit High School (CA)
Jesuit High School Portland (OR)
Jesuit Refugee Service/USA
Jesuit Schools Network
Jesuit Volunteer Corps
Jesuit Volunteer Corps Northwest
John Carroll University (OH)
Junipero Serra High School (CA)
Kalmanovitz Initiative for Labor and the Working Poor
Kino Border Initiative
L'Arche Greater Washington DC (DC)
L'Arche St. Louis (MO)
La Salle University (PA)
Le Moyne College (NY)
Loyola Academy (IL)
Loyola Blakefield (MD)
Loyola High School of Los Angeles (CA)
Loyola Marymount University (CA)
Loyola School (NY)
Loyola University Chicago (IL)
Loyola University Maryland (MD)
Loyola University New Orleans (LA)
Maggie's Place
Magis Americas
Magnificat High School (OH)
Manhattan College (NY)
Marquette University (WI)
Maryknoll Lay Missioners
Maryvale Preparatory School (MD)
McQuaid Jesuit (NY)
McQuaid Jesuit High School (NY)
Merion Mercy Academy (PA)
Mount Mary University
Notre Dame Academy (MA)
Notre Dame College (OH)
Notre Dame San Jose (CA)
Notre Dame School of Manhattan (NY)
NPH USA
Orbis Books
Pax Christi USA
Presentation High School (CA)
Red Cloud Indian School (SD)
Regis High School (NY)
Regis Jesuit High School (CO)
Regis University (CO)
Rehumanize International
Richmond Diocese
Rockhurst High School (MO)
Rockhurst University (MO)
Sacred Heart Preparatory (CA)
Saint Andrew Nativity School (OR)
Saint Augustine High School (CA)
Saint Francis Xavier Catholic Church (MO)
Saint Ignatius Church (MD)
Saint Ignatius College Prep (IL)
Saint Ignatius College Preparatory (CA)
Saint Ignatius High School (OH)
Saint Ignatius Loyola Parish (CA)
Saint John's Jesuit High School and Academy (OH)
Saint John's Prep (MA)
Saint John's School of Theology and Seminary (MN)
Saint Joseph Academy (MO)
Saint Joseph Academy (OH)
Saint Joseph's Preparatory School (PA)
Saint Joseph's University (PA)
Saint Louis University (MO)
Saint Louis University High School (MO)
Saint Patrick Catholic Community
Saint Peter's Catholic Church (NC)
Saint Peter's Preparatory School (NJ)
Saint Peter's University (NJ)
Saint Ursula Academy-Cincinnati (OH)
Saint Viator (IL)
Saint Xavier High School (OH)
Salesianum School (DE)
Santa Clara University (CA)
Scranton Preparatory School (PA)
Seattle Preparatory School (WA)
Seattle University (WA)
Serra High School (CA)
Sisters of Mercy of the Americas (MD)
Sisters of the Precious Blood
Sisters of the Presentation of the BVM
Sojourners
Spring Hill College (AL)
Stone Ridge School (MD)
Stone Ridge School of the Sacred Heart (MD)
Stonehill College (MA)
The Catholic University of America (DC)
The National Catholic Reporter
UNCW Catholic Student Center (NC)
University of Detroit Jesuit High School (MI)
University of Detroit Mercy (MI)
University of Notre Dame (IN)
University of San Francisco (CA)
University of Scranton (PA)
Ursuline College (OH)
US Catholic Sisters Against Human Trafficking
USF McGrath Institute for Jesuit Catholic Education
Villa Maria Academy High School (PA)
Villanova University (PA)
Walsh Jesuit High School (OH)
Xavier College Preparatory High School (CA)
Xavier High School (NY)
Xavier University (OH)
Are you a student or alumnus/a?
Student
Graduate Student
Alumnus/a
None of the Above
Role at Institution
Staff
Parishioner
Administrator
Diversity, Multicultural Affairs Staff
Immersion Coordinator
Campus Minister
Service/Justice Minister
Faculty
Other
Graduation Year
Job Title
If applicable
Your Interests
I am an active advocate/organizer in:
Migration Justice
Ecological Justice
Racial Justice
I am interested in:
Advocacy
Art as Activism
Criminal Justice
Ecological Justice
Economic Justice
Ignatian Spirituality
Migration Justice
Racial Justice
Δ
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