Jr Hi Spring Retreat Registration

Where: Camp Ojibway
When: April 23 - 25, 2010
Time: Check in Friday at 5:00
(EAT BEFORE YOU COME!!)
Cost: $60.00

What to bring: Warm clothes Sleeping bag Boots or change of shoes Bible & pen Personal stuff - toothbrush, deodorant, clean underwear, etc…. A Friend!!

What to leave at home: Bad attitudes tobacco, alcohol, fireworks, or anything illegal Parents or pets Brothers or sisters not in JH CELL PHONES IPODS OR DISCMANS

You may use this on-line form instead of the paper form that has also been distributed. Either form, paper or on-line is acceptable. If you complete the on-line form, you DO NOT need to turn in the paper form.

*Student's First Name

*Last Name

*Grade

*E-mail Address
If you have none, please enter none@none.com (You will not receive an e-mail receipt, of course.)

*Home Phone

*Street Address

*City

*State

*Zip

*Parent/Guardian Name

*Emergency Phone

Allergies

Medications

Physical Limitations

*Insurance Company

*Policy Number

*Policy Holder's Name

*Permission
I have read the legal notice at the bottom of this page and as the parent/guardian I give my permission to attend the spring retreat.

*Required

Please submit your registration first, then use the Buy Now button to make your payment. You may also pay by cash or check at the door.

Number of Students

1 Student $60.00 2 Students $120.00 3 Students $180.00

Legal Notice:

I give permission for my above-named son/daughter to join the Junior High School Group of Hope Presbyterian Church for the Junior High Spring Retreat at Camp Ojibway from Friday April 23 at 5:00pm until Sunday April 25 at 5:00pm. I understand that the group will be traveling by rented bus or vans and the group will check in at Hope at 5:00pm Friday and return at 5pm Sunday.. I also understand this event is $60.00 and includes lodging, food, transportation and More!! If you have any questions call Cesar Castillejos at 612/866-4055 ext 3152.

I hereby release Hope Presbyterian Church, its staff and sponsors, from responsibility and liability for any injury or illness that my child may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity, as agent for me, to consent to an X-ray examination, medical, dental or surgical diagnosis, treatment or hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor's office or in any hospital. I expect to be contacted as soon as possible.