Local Mission Chaperone 2025 Registration Form
Chaperone Local Mission
June 8-11, 2025
Held at St. Margaret Mary Parish, Neenah
Travel area: Neenah/Menasha and surrounding communities 

Thank you for you for being a volunteer Chaperone for the Local Mission Experience June 9-12! Please mark your calendar for a Chaperone meeting on May 28 at 7pm at St. Margaret Mary Parish and service dates and times below. 

Mission Trip Adult Chaperone Hours:
May 28, 7:00pm-8:00pm (St. Margaret Mary Parish Office, 439 Washing Ave. Neenah)
June 8, 4:45pm-7:15pm (Meet at St. Gabriel Parish)
June 9 - June 11 8:45am-4:05pm (Meet at St. Margaret Mary Parish)

Contact: Tina Peirick at 920-729-4560 or tpeirick@smcatholischools.org with questions. Thank you!

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Email *
First Name *
Last Name *
Address/State/Zip *
Cell Phone Number *
Can you receive texts?  *
Emergency Contact Name 
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Emergency Contact Phone Number
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Shirt Size - All Adult sizes
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Parish Name
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How many people can your Vehicle hold including you?
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Do you have a valid drivers license?  *
Are you over the age of 21? *
Are you an insured driver?  *
I will bring a copy of my drivers license and insurance card to the Chaperone meeting.  *
Are you VIRTUS trained?
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Have you completed the 2025 update for VIRTUS training? *
Who do you prefer to have in your group?
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Do you prefer certain a certain age group to work with?
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List a name of a youth or a school you'd like to be in work group with. 
This is my first year volunteering with the Local Mission Trip!
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Briefly share your experience working with youth?
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What is one cool fact to share about you? (That may be shared with the entire group)
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I will be available on June 8, 4:45pm-7:15pm and June 9-11, 8:45am-4:15pm to Chaperone a small group for the Local Mission Experience.
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I will be at the Chaperone meeting at St. Margaret Mary Parish at 7pm on May 28, 2025 (Wednesday) in Friendship Hall (Lower level of Church)
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I give the Neenah-Menasha Parishes permission to use photos or video images of me in any publications.

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Please let us know if you have any questions or concerns, thank you!
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A copy of your responses will be emailed to the address you provided.
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