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Winter Retreat is sponsored by the Evangelical Free Rocky Mountain District

MEET @ the church: Friday,February 26th @ 4pm
RETURN: Sunday, February 28th about 12:00 pm
Cost: $110 if registration & deposit are received by Feb. 1st - $120 if registration & deposit received after Feb. 1st (fee includes transportation, lodging, three meals on Saturday and breakfast on Sunday, sweatshirt, & conference costs)
A $55 deposit is due by February 8th.

What to Bring: Sack dinner (or money for dinner) for the way up; money for lunch on the way back on Sunday; any additional spending money; Bible, pen, warm clothes, modest swimwear, personal items, and water bottle (bedding & towels are provided); games & snacks are optional.

The weekend will include: great fellowship, an opportunity to look at the real you, and tons of fun! (swimming, ice skating & coffee shop!)

Worship with: Justin Fox (http://www.justinfox.com)
Our speaker: Cory Bragg

Sign me up for WINTER RETREAT!

By joining us for this retreat, students agree to respect and follow the authority of the group leadership, obey all guidelines for the retreat both stated and implied, respect the rights of others, and attend all group meetings and meals. Students also agree not to bring any fireworks, alcohol, tobacco or drugs. If a student does not comply in these areas, we will not hesitate to call the student’s parents to come and pick up their son or daughter.
Name:
Address:
City: State:  Zip:
Phone:
School:
Grade:
Date of Birth:   ex:  1/10/1995
E-mail: 
Sweatshirt Size 
(adult size):
PERMISSION
I hereby give permission for the above named student to participate in Middle School Winter Retreat to be held February 26-28, 2010 at the YMCA in Estes Park, CO. I do hereby release, forever discharge and agree to hold harmless any participating churches from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses of any nature which may be incurred by the participant while participating in said retreat. Furthermore, I hereby assume all risk of personal injury, sickness, death or damage as a result of participation in retreat activities involved therein. I further hereby agree to indemnify any participating churches, their directors, employees and volunteers for any liability sustained by any participating churches as a result of the negligent, willful or intentional acts of said participant. In signing, I do understand and agree that my deposit is nonrefundable. It is also understood that my student will obey all regulations and follow instructions or be sent home at my expense without refund of monies paid.

Date
Digital Signature of Parent or Guardian (enter your initials)

PARENT INFORMATION
Parent/Guardian's Name:  
Best # to be reached:
Alternate Phone #:
EMERGENCY/HEALTH INFORMATION
Emergency Contact Name:
Best # to be reached:
Medical insurance carrier:
Policy/Group #:
Other information to notify staff of (allergies/other health problems)
My child has permission to participate in all activities, unless noted. I give permission to medical personnel to order x-rays, routine tests and treatment for the health of my child, and in the event I cannot be reached, I give permission to hospitalize and secure proper treatment for my child as needed.

Date
Digital Signature of Parent or Guardian (enter your initials)

Click to transmit your information
to Grace Evangelical Free Church