NASHVILLE PRESBYTERY YOUTH RETREAT REGISTRATION FORM

November 20-22, 2015

Cost: $105 Youth & Adults, after deadline $115

Deadline to register is due October 30th, late charge will be enforced

This form must be completed by all persons attending the retreat and brought to camp. All persons must sign the covenant and youth must have a parent or guardian signature. Please Note: THIS IS A TOBACCO FREE RETREAT FOR ALL PERSONS. No tobacco products are permitted at all during the retreat, including adults.

For more info call Meredith Bone, (615)347-3483

IF YOU WOULD LIKE A T-SHIRT WITH THIS WEEKEND’S THEME, PLEASE INCLUDE AN EXTRA $10 AND

INDICATE SIZE HERE ______

NAME______Age______Grade or Adult______GENDER______

ADDRESS:______Phone:(______)______

E-MAIL ADDRESS:______

CITY:______STATE:______ZIP:______

NAME OF CHURCH:______

IN CASE OF AN EMERGENCY NOTIFY: ______

PHONE #______

MEDICAL INFORMATION: List any medical problems you have or any medical attention needed. Please

include allergies and any medications currently taken.

INSURANCE COMPANY:______

POLICY # ______GROUP # ______

FIRST AID: By signing below, I HERBY GIVE PERMISSION TO THE FIRST AID DIRECTOR TO ADMINISTER FIRST AID AND /OR SEEK MEDICAL ASSISTANCE AS NEEDED. I ALSO AGREE TO COVER ANY PAYMENTS FOR MEDICAL ATTENTION.

I ALSO AGREE TO COVER THE COST OF ANY DAMAGE MY CHILD MAY CAUSE TO THE FACILITES THEY WILL BE USING. I ALSO AGREE NOT TO HOLD THE CAMP, RETREAT ORGANIZERS, PRESBYTERY, AND OR CHURCHES RESPONSIBLE FOR ANY INJURY THAT MAY BE A RESULT OF MY CHILDS ACTIONS.

SIGNATURE OF GUARDIAN OR PARENT:______

COVENANT: (ALL PERSONS ATTENDING MUST SIGN): I, ______

Promise to obey all retreat requirements as set forth by the Presbyterial Youth council and its adult leaders and to actively participate in all retreat activities: Bible Study, Worship, Recreation, Lights out, etc.

SUGGESTED ITEMS TO BRING: BIBLE, snacks or money for snacks, bedding or sleeping bag, pillow, flashlight, towel and toiletries, warm and casual clothing, jacket, recreational equipment.

ITEMS NOT TO BRING: Fireworks, stink bombs, weapons, balloons, music with questionable lyrics, drugs not prescribed and listed above, tobacco products.

IMPORTANT: Each church is responsible for sending 1 adult (minimum age 21, women for female youth and men for male youth) for every 5- 7 youth. If your church is unable to meet this requirement, you must make prior arrangements for an adult from another church to be responsible for your youth. Failure to do so may result in your youth not being allowed to attend.

*****Registration forms and money must be received by October 30th to receive the pre-registered price. *****

Forms should be given to your youth leader and then sent as a group to:

Lisa Cook, Brenthaven CP Church; 516 Franklin Rd; Brentwood, TN 37027
Church Checks should be made out to: Nashville Presbytery Youth, Personal Checks should be made out to your church.