Middle School Camp at Camp to Know Him

Middle School Camp at Camp to Know Him

July 17-20, 2018

This trip is open to Students in Grades 6-8th. We will only accept COMPLETED APPLICATIONS (including parent’s signature) along with FULL PAYMENT. If you have any questions, please call the Student Ministries Office at 770-261-1776.

ONE FORM PER APPLICANT PLEASE!

I. Student Information

◊ Male◊ Female

Name

AddressCity, Zip Code

Home Phone NumberE-mail Address

◊ Member of RUMC◊ Visitor

Guest of:HomeChurch:

Date of BirthAge

SchoolGrade

T-Shirt Size: ( )Sm ( )Med ( )Lg ( )XL ( )XXL

Please list one 1 student who you’d like to be roommates with while on the retreat:

Name ______

[ ] It doesn’t matter to me…I love everyone!

II. Roswell Student Ministry Rules

1. No alcohol or tobacco in any form is ever permitted on youth trips.

2. You will be respectful to your adult volunteers and Student Ministry Staff.

3. You are never to go anywhere alone.

4. Remember you are representing Roswell United Methodist Church at all times.

5. You are to conduct yourself as a Christian by your words and deeds at all times.

6. No profanity.

7. No fireworks, weapons, lighters, or matches are allowed.

8. No guys and girls should ever be alone together.

9. If you are in question whether or not something is allowed please ask an adult.

I have read and understand all of the Roswell Student Ministry Rules. By signing this form I agree to follow each of these rules. If I break a rule I understand that I can be sent home, at my parent’s expense, as a result.

√

Student SignatureDate

III. Trip Costs

The total cost for Middle School Camp ‘18 is $325and includes food, lodging, all materials and transportation to/from RoswellUMC.Deadline for registration is July 9. Please make checks payable to RoswellUnitedMethodistChurch. Please include payment with your completed application or call the Student Ministries Office to make other arrangements for payment. Scholarships are available. Refund Policy: Full refund available up to 30 days before trip departure. No refunds after that time. Any questions? Please emailJason Scott at

IV. Legal Stuff

For Parents:

If there are any existing medical limitations, including allergies or food allergies, which would affect or limit your child's activity, or of which medical personnel should be made aware, please indicate below. Medical conditions, current prescriptions/regular medication, and or special instructions are:

Roswell United Methodist Church, Inc. including employees and representatives shall be held harmless from any suit, action, damages, or claims at law or otherwise, resulting from or arising out of any injury, accident, or illness which may befall (name of Student) ______and or/his property while a participant in the event.

The undersigned parent or guardian hereby authorizes RoswellUnitedMethodistChurch representatives to take such action as may be necessary for the medical care or treatment including the administration of medication, performing of surgery, or other such action as needed in the event of injury or illness of participant when parent or guardian cannot be reached for authorization. This authorization may be presented to medical personnel without liability of said personnel to seek further authority.

In the event of a medical emergency the Student Ministries Team will make every effort to contact a parent before seeking medical treatment. If we are unable to reach a parent, we will exercise good judgment and seek medical treatment as needed. RoswellUMC will pay for the medical treatment and the undersigned parent or guardian will be responsible for the entire bill.

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Signature of parent or guardian Date

Please give us the names of two people that we may contact in the event of an emergency during the trip:

Name

Relationship To Student

Phone Number

Name

Relationship To Student

Phone Number

Roswell Student Ministry Staff and Adult volunteers will not be responsible for items that are lost, damaged, or stolen during the course of this retreat. Students will be responsible for their personal items such as wallets, i-pods, cell phones, etc.

I have read and understand the above statement: ______(Student’s Initials)

DISCLAIMER: I understand that my photograph may be taken while on this trip and posted on the RUMC or Roswell Student Ministry websites or the RUMC or Roswell Student Ministry Facebook pages.

__ I understand and allow __ I understand and do not allow

______

Signature of StudentDateSignature of GuardianDate

*Please make sure you have filled out a 2018 Health form for each student going on the trip. These can be found at roswellstudentministry.com/resources .