ABOUT

Calling all of our Basilica high schoolers! In this season of thanksgiving, let’s give back to the older adults in our community.

Join us for an outing to visit the residents at Woodbine Rehabilitation and Healthcare Center in Alexandria, VA, on Wednesday, November 19 beginning at 5:30 PM. We aim to share our presence and joy with the older adults in residence by visiting with them and assisting them with creating a gratitude craft.

Afterwards, we will gather in Casa Frassati to eat a pizza dinner and attend Adoration. The evening will end at 8:15 PM.

DETAILS

5:30 PM: Meet at Casa Frassati (307 S. Royal St., Alexandria) and depart for Woodbine Rehabilitation & Healthcare Center (2729 King Street, Alexandria, VA 22302). Transportation will be provided.

6-7 PM: Visit with the residents at Woodbine and help them create a gratitude craft

7:20 PM: Return to Casa Frassati for a pizza dinner

7:40 PM: Attend Adoration and Benediction in the Basilica

8:15 PM: Depart

SIGN UP

To sign up, please have a parent complete the permission form below!

High School Visit to Woodbine

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Permission Form

Participant Name*

First Last

Date of Birth*

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School*

Grade in 2025-26*

Parent/Guardian Name*

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Address*

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Parent/Guardian Primary Phone*

Parent/Guardian Secondary Phone

Parent/Guardian Email*

Safety

As the participant, I agree to follow all procedures, safety precautions, and rules and regulations set forth by the Diocese and the Parish.

Signature of Youth Participant*

Date*

MM slash DD slash YYYY

Parental Permission and Liability Release*

As parent/legal guardian of the participant named above, I give my permission to participate fully in the Basilica of Saint Mary's trip to Woodbine Rehabilitation & Healthcare Center on Wednesday, November 19th, 2025 at Woodbine Rehabilitation & Healthcare Center, 2729 King St., Alexandria, VA 22302. I agree to indemnify and hereby release the Most Reverend Michael F. Burbidge 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 when a condition or injury arises that is serious enough that a reasonable person would seek care right away. 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, the Arlington Catholic Herald, and/or Woodbine Rehabilitation and Healthcare Center 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.

Health Information

Primary Health Provider*

Phone Number*

Insurance Company*

Policy Number*

Emergency Contact Name*

First Last

Relationship*

Phone Number*

Known allergies (including any allergies to medicine)*

Any other medical problems which should be noted*

Consent*

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.

Signature of Parent/Guardian*

Date*

MM slash DD slash YYYY

Are you registered for the Youth Apostolate for the 2025-26 school year?

Yes

No

QUESTIONS?

Contact our team at yaya@stmaryoldtown.org.