ITEMS TO PACK Bring money for dinner on the way to camp
Bring All Your Adventure Seeking Buddies Paintball* Polar Bear Dip Night Games Low Ropes Climbing Tower Chapel
Football High Ropes Challenge Course Horseback Riding* Zipline
❏ Warm bedding (and pillow) ❏ Warm clothes and jacket ❏ Old clothes ❏ Long pants ❏ Two pairs of shoes (one old pair) ❏ Flashlight ❏ No electronics allowed ❏ Toiletries ❏ Bible ❏ Notebook ❏ Pen ❏ Swimsuit ❏ Towel
* Additional permission signature and $10 fee required.
Berean Baptist Church 309 E Co Rd 42, Burnsville, MN 55306 Youth Office 952.223.1847 www.epicSM.com Emergency Camp Phone Number 320.732.3218
Junior & Senior High
Fall Retreat OCTOBER 20-23 2011
Fall Retreat 2011 Permission Release
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NAME ___________________________________________________
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ADDRESS ________________________________________________ CITY _____________________ STATE ________ ZIP ______________ PHONE (__________) ____________-______________ GRADE ______
Speaker Cesar Castillejos
❑ YES ❑ NO IF YES, BROUGHT BY ___________________ T-SHIRT SIZE ❑ S ❑ M ❑ L ❑ XL VISITOR?
CUT OFF AND RETURN
l AT l C a E I EP F R T E R
I give permission for my child to join Epic Student Ministries of Berean Baptist Church on the EPIC FALL RETREAT `11 Weekend at Lake Beauty Bible Camp from Oct. 20- 23. I understand that the group will be traveling by buses and 15-passenger vans. I also understand the cost includes food, transportation, and all programming. I agree that the staff member or adult in charge is authorized to solicit medical care in the best interest of my child in case of an emergency arising during the course of said minor’s attendance at the aforesaid function. I further understand and agree that my medical insurance coverage or other applicable insurance coverage, if any, are primary coverage for the protection of the child and that any insurance coverage provided by Berean Baptist Church are secondary coverage. All participants must also have a “Berean Baptist Medical Consent” form on file at the church office. They can be found on-line at www.epicsm.com. If you are unsure as to how to answer any of the questions, please contact us at 952.223.1847. YES NO 1. The church has a completed copy of the Berean Baptist Church Medical Consent form, signed by me (parent/legal guardian), on file for this current school year. YES NO 2. All health and insurance information (regarding question #1) is accurate and up-to-date. YES NO 3. All emergency phone numbers and medical information (regarding question #1) are up-to-date. YES NO 4. I give my consent to use pictures or video of my student on the Berean website or for event promotion.
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Signature _________________________________________________ DATE ________/________/________
(PARENT OR LEGAL GUARDIAN)
EMERGENCY PHONE NO. (__________) ____________-______________ PAID:
Adventure Destination: Cost: $180, plus $5-10 cash for dinner on
the ride up to camp. Includes transportation, program & meals at camp. Registration Deadline: Oct 12, 2011 Scholarship forms available online at www.bereanbaptist.com/events
Lake Beauty Bible Camp Long Prairie, MN 56347-9734 Phone 320.732.3218 www.lbbc.com Drop Off: At Berean ~ Thursday, Oct. 20 at 2:30 Pick Up: At Berean ~ Sunday, Oct. 23 at 2:30 Both at Berean’s Main Entrance
❑ CASH ❑ CHECK* (# ____________ AMT. _______________) ❑ CREDIT VOUCHER (AMT. ___________________)
*MAKE CHECKS PAYABLE TO BEREAN BAPTIST CHURCH ——————————————————————————————— Lake Beauty Bible Camp Horse Trail Ride Permission/Release Form Camper Name (please print):_________________________________________ Horseback Trail Rides: I hereby give permission, as indicated by my signature below, for my child (the camper named above) to participate in Lake Beauty’s trail rides. I understand that signing below does not register my child for trail rides; rather, it gives permission for them to participate. I also understand that campers participating in horseback riding activities will be given introductory safety instructions before going on trail rides and that all riders will be required to wear protective head gear which the camp provides. It is my understanding that camp personnel seek to ensure a safe, educational, and fun program.
Signature _________________________________________________ DATE ________/________/________
(PARENT OR LEGAL GUARDIAN)