Our Saviour's Lutheran Church
Servant/Retreat/Immersion Group (circle or highlight one)
2018 Spring/Summer/Fall/Winter (circle or highlight one)
Preliminary Statement of Intent and Request of Date
Date of Application: ______
Organization: ______
Address: ______
City: ______State: _____Zip Code: ______
A. Contact Information:
Coordinator: ______
Telephone: Area Code (______) ______Fax: Area Code (______) ______
E-Mail: ______
B. Dates
Plan to arrive on Saturday afternoon and leave Friday morning/afternoon. (This is a change from recent years.) Arriving on Saturday is important to us as we ask that you to be part of our worshiping community on Sunday. (The August week of the Rocky Boy Pow-wow has different start and end dates. Please, consult our on-line calendar.)
Preferred Date:Alternative Date:
Arrival: ______Arrival: ______
Departure: ______Departure: ______
C. Potential number of attendees:Adults _____Youth _____ (Jr. High)_____ (Sr. High)
The cost per person is $350. This covers food, lodging, and program costs. A deposit of $1,000 is required with two weeks once your dates are confirmed. $500 is non-refundable, $500 is refundable up to April 15th.
The minimum number accepted is 6 participants for a group. Smaller groups & individuals are welcome to come, but may not have the same experiences as a larger group. The maximize number (including all adult leaders) is 35, if you are expecting us to provide transportation. A larger group is possible (up to ~45, which will depend on the female/male breakdown of the group ). Transportation for over 35 participants is the responsibility of the group. Please note, another small group or individuals interested in the same week may be combined with yours. If this is the case, everyone will be sharing living space and work projects. If your group is small, consider partnering with another congregation to increase the size of your group.
D. Services
Bedding: Participants must bring their own sleeping bags or bed rolls. Towels, pillows & pillow cases are provided. (Because of airline baggage costs, shipping things by UPS or train, may be an option to be considered.)
Teepees may be available for sleeping space. You would need to bring your own pad or air mattress.
Is this something you are interested in?YesNo(circle one)
Space for tents is available, if you want to bring your own.
Is this something you are interested in?YesNo(circle one)
A limited number of RV hook-ups are available
Is this something you are interested in?YesNo(circle one)
Transportation
Will transport be needed from airport (Great Falls) or train (Havre)?
(There is a fee for shuttle service based on the 2018 IRS rates.)YesNo(circle one)
Additional information: Daily chores are assigned to everyone in order to help with food preparation, meal clean-up, and to maintain and clean the facility as a whole for your group’s use. There is no public laundry facility on-site. Please plan clothing needs appropriately.
E. Abilities of Attendees
Vacation Bible School Day CampYesNo(circle one)
Staff from Flathead Lutheran Bible Camp will be here for two weeks in July 2018 (see our on-line Calendar for which weeks). These are the only weeks we organize VBS Day Camp. If your group wants to do VBS, you are welcome to bring own materials and organize a different week.
Christian Sports CampYesNo(circle one)
This could be done on non-VBS weeks. Your group would organize and run the activities and provide the instructors.
Skills:
Carpenter:YesNo(circle one)Electrician:YesNo(circle one)
Mechanic:YesNo(circle one)Painter:YesNo(circle one)
Plumber:YesNo(circle one)
Abilities:
Assist in Worship/Music/Preach:YesNo(circle one)
Computer (Word, Excel, Publisher, etc.):YesNo(circle one)
Crafts:YesNo(circle one)Painting:YesNo(circle one)
Yard work:YesNo(circle one)General Work:YesNo(circle one)
Other skills or abilities within your group: ______
F. We try to include the following things in your cross-cultural experience.
BeadingNative Culture and History
Dance and drummingdemonstrationNative Spirituality
The following are things we can try to arrange if you are interested (additional cost may be associated with each):
Sweat Lodge History of the area – Havre Underground, Fort Assiniboine
Other interests ______
G. Medical/Emergency Form
Agree to supply a medical/emergency form for each attendee: Yes No (circle one)
(Minor and Adult Forms will be e-mailed or sent, along with a Group Registration Form)
______Signature______Date
______(Please Print Name and Position)
H. The sending organization must certify that each person over 18 years of old has a Background Check on file.
I. Once your group has paid the deposit additional information will be sent to you.
NOTE: Please mail (499 Mission Taylor Rd, Box Elder, MT 59521-8983), fax (406-395-4076), or e-mail ( and Cc. ) this completed form back to Our Saviour's Lutheran Church as soon as possible to reserve the dates you are interested in. You will receive a request for a deposit to hold your place once your dates are confirmed. (revised 6 February 2018)
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