Save the date
Spring retreat March 4-5 at Heartland Center
2018 Youth tubing rally
Registration deadline
Monday, January 8th
Beginning with mixers, worship, service, and lunch at LAMPand concluding at Snow Creek Ski Area, for Heartland Presbytery youth and their chaperones.
$40 covers tubing ticket, lunch, and snack after tubing. ($15 if you are not tubing).
Please bring a permission slip for each person and give it to your responsible adult. If needed, the presbytery can email you a blank form, or if your church uses a similar form, just bring it.
Please bring plastic grocery bags. We will need lots of them to complete each mat we will make.
HEARTLAND PRESBYTERY’S YOUTH RETREAT
PERMISSION FORM
Winter tubing event
Name
of Youth:________________________________________________________________
First Middle Last
Home
address:_________________________________________________________________
Street
address city/state/zip
Youth
cell phone #:________________________ Grade in school:_______________________
Parent/Guardian
name_________________________Cell phone #______________________
Parent/Guardian
name_________________________Cell phone #______________________
Emergency
contact name and # (other than parent):_________________________________
______________________________________________________________________________
Medical Information
Please list any allergies:_________________________________________________________
_____________________________________________________________________________
Medical/emotional/mental/other conditions of which leaders should be
aware:________________________________________________________________________
Medications requiring special dispensing/storage:___________________________________
Primary Physician’s Name and #:_________________________________________________
Health Insurance (name of insurer)_________________________Policy #________________
By signing below, I give consent for my child to participate in this event. I also give my child permission to be given medical treatment, medical assistance, assessment and surgery or life saving measures if needed.
Signature ________________________________________________________
Relationship to child ________________________ Date _________________________