Really, It’s in the Bible!!!

Leaving
Friday, September 21, 2018 at 6:00 pm

Returning
Sunday, September 23 at noon

Where
Epworth House, Wesley Woods Conference Center, Williams Bay, WI

Who
All students in 6th through 12th grade

Cost
$60 per student

Packing List

  • bedding (sheets and blanket or sleeping bag and pillow)
  • towel and toiletries
  • clothes for three days
  • Bible
  • snack to share

Questions
Contact Rev Nick Nicholas or 630 291 1380

Permission Slip and Student Contract

All fields are required unless indicated

Your Name
Your Email

Student Information

 
Student's Name
Grade Completed
Home Address
City, State
Birthday

Gender
FemaleMale

Emergency Contact Information

Contact Name
Relation to Student
 
Phone
Alternate Phone

Health Information

 
Food Allergies
YesNo
If yes, please list
 
Medical Concerns
YesNo
If yes, please explain:

Medical Release Authorization and Hold Harmless Agreement

I , authorize the Community Methodist Church to use their best judgment in the hiring of necessary health-care professionals, and I give my permission to the health-care professional to provide medical services as he or she deems necessary. I will pay for any medical expenses so incurred. I also give my permission for the church’s children and/or youth leaders to restrict my child from participation from any be harmful to my child.
I also verify that my child is physically fit and possess the necessary skills to safely participate in these activities. I therefore give my permission to the church to allow my child to participate in the activities allowed by the church/camp. I also hereby give my permission for my child to be transported by pre-authorized individuals determined by the church. I hold harmless Community Methodist Church (CUMC) and all CMUC Staff or volunteers from any and all claims, actions and judgments related to this event. I claim full responsibility for all damages to person and property my child may intentionally or unintentionally inflict while on this retreat.

Insurance Carrier
Policy Number
Parent Signature
Date

Student Conduct Contract

I , understand that there is to be no alcohol consumption, smoking, sexual activity or damaging behavior of any kind while on this retreat. I understand and agree to follow the instructions of all adult leaders on this trip and also agree to obey all rules, written or verbal. I understand that if I break these rules it may result in my expulsion from this trip at my parent’s expense.
 
Student Signature
Date

Parent Signature
Date

 

Authorization

 
Do you authorize Community UMC to photograph/film your child with activities associated with this retreat?
YesNo  

Payment

I will use PayPal on the next step to make my paymentI will drop a check off in the offering plate or to the officeI will mail a check into the office

If you do not wish to use PayPal to make your payment, simply close the PayPal window when it appears.

Consent

Your electronic signature here and above is your consent for your child to participate in this retreat, and that all the above information is accurate.

Parent Signature