2018 Winter Youth Retreat to Mammoth Lakes California We will be going up to Mammoth for a four day three night stay February 16th-19th, 2018. This is over Presidents Day weekend and goes Friday through Monday. The following is an information packet containing all the details about the Retreat and all applicable forms and waivers which need to be returned along with total payment by Tuesday February 5, 2018. Deposits: We are breaking up the cost over 4 deposits leading up to the retreat in an effort to afford the deposits required by the camp. The deposit schedule is as follows: 1st Deposit: $80 Due: January 2, 2018 2nd Deposit: $80 Due: January 23, 2018 3rd Deposit: $80 Due: February 6, 2017 4th Deposit: $85 Due: February 13, 2017 The cost for this retreat is $325.00 per person. Hopefully this deposit schedule will also help in easing the total cost. There will be scholarships available, for scholarships please speak to Jeff Paisano, Youth Pastor. (Contact info listed below) Snowboarding/Skiing/Sleds: One of the options for an activity on this retreat will be snowboarding at Mammoth Mountain Ski and Snowboard Resort or June Lake Resort. For this activity there will be a separate information page. Please read thoroughly to make sure you know all the details and costs involved. For those not going to Mammoth, there is an option to go to Sledz, an amazing sled resort – this will cost $25 per person additional to retreat costs and can be paid along with retreat money. “ALL FORMS AND THE COST FOR THE RETREAT (MONEY) ARE DUE ON OR BEFORE TUESDAY NIGHT FEBRUARY 5, 2018 AT THE

NORMAL FACEDOWN YOUTH BIBLE STUDY.”

Departure and Return Information: We will meet at Reverence (22081 Hidalgo, MV) Friday morning Feb. 16 at 5:00am and leave by 6:30.

We will then be returning to the same location on Monday Feb. 19th around 7:30pm. We will have all retreat goers notify parents in the event that we run late or by God’s grace we are early.

For more information or questions please call or e-mail: Jeff Paisano Cell: 949-929-4493

jeff.paisano@reverencechurch.org www.facedownyouth.org

Retreat Agenda

Friday 5:00am Meet at RBC New Church Property with all luggage. 6:30am Leave for Mammoth Lakes CA 2:00pm Arrive and unpack 6:00pm Dinner 8:00pm Intro to “Winter Retreat Bible Study 1” Worship- Worship team. 10:00pm Games / Bonfire 11:00pm Lights Out Saturday 7:00am Personal Devotion Time 8:00am Breakfast 9:00am Morning Worship and Breakout Session #1 11:00am Activity: Serious snow play session 12:00pm Lunch – while out and about (Sack Lunches) 4-6pm Rest Session (nap, relax… just make sure you’re awake for bible study) 6:00pm Dinner 8:30pm “Bible Study 2” – Worship- Facedown Worship team. 9:30pm Games/Bonfire 11:00pm Lights out Sunday 7:00am Snowboarding Group leaves for Mountain (breakfast on hill) 8:00am Breakfast (for group staying) 9:00am Morning Devotion – Worship – Facedown Worship Team 10:00am Activity: Sledz Tube Park and Gondola to Canyon Lodge 12:00pm Lunch @ Canyon Lodge pack a sack or bring $ to purchase lunch there. 4:00pm Nap and relax session till dinner. 6:00pm Dinner 8:30pm “Bible Study 3” – Worship – Facedown Worship Team 10:00pm Games / Bonfire 11:00pm Lights Out Monday 8:00am Breakfast 9:00am “Closing Bible Study 4” – Worship – Facedown Worship Team 10:00am Clean Cabins 12:00pm Leave to return home lunch on road. 7:00pm-ish Arrive home

Winter Retreat RBC Facedown Youth As an option for one of the activities on our Facedown Youth Winter Retreat, we will be going snowboarding/skiing at Mammoth Mountain Ski and Snowboard Resort. Again this activity is not required; there will be optional activities for those not going snowboarding/skiing that day. Our plan is to go on Sunday for a full day session starting at 8:00am and ending at 4:00pm. Following are all the details for the snowboarding/skiing activity.

Details: • We will go for Full Day on Sunday starting at 8:00am going till 4:00pm. We will stay as a group on the hill. • All costs for snowboarding/skiing are the sole responsibility of each individual participating including Lift Tickets and

any Rental Equipment needed. Reverence Bible Church (RBC) Facedown Youth Ministry will not be financially responsible for any costs involved in this activity. If parents would like to have the RBC Facedown Youth Ministry (RBCFYM) Leadership hold the money for their child (ren) that will need to be set up between the parents and the Leadership team and is an option.

• Each individual participant going skiing or snowboarding will be responsible for all equipment needed whether they are bringing their own equipment, borrowing or planning to rent. There will be an option to rent equipment at the resort, and this is recommended for all first time skiers and snowboarders. The Resort always has top quality equipment and they streamline the process for quick expedition. A leader will be taking a group of people needing to rent to the respective rental location at the Resort and overseeing the process. Again (RBCFYM) will not be responsible for any costs of rental equipment.

• You may bring your own equipment. (RBCFYM) will not be responsible for any lost or stolen personal items. • Kids/Students/Individuals may not participate in snowboarding or skiing while on this Retreat without a Special

Activities Waiver/Release of Liability and Permit to Treat signed by a legal parent or guardian. All that said, here are the current costs as we know them from their online advertising. It is possible that there may be discounts available to our group size as well as additional costs that they may not have disclosed. The prices are approximates.

Prices: (per 2016) Full Day Lift Ticket: Youth 13-18 yrs old $80.00 Adult $107 Full Day Snowboard/ski Rental Package: Youth: $40 Adult $40

TOTAL APPROXIMATED COST’S WITH RENTAL : YOUTH: 13-18 YRS OLD: $120.00 ADULT: $147.00

What you’ll Need Following is a list of clothes items that are recommended for this activity. Warm Clothes –

• Pants, snow/powder pants • Jacket, • Long Johns (ask your parents), • Gloves, • Goggles/eye protection,

• Helmet (STRONGLY RECOMMENDED but not required),

• Change of dry clothes, • Hat, Beanie.

Following is a list of Equipment that is recommended whether renting or bringing your own:

• Board/skis, • Boots, • Bindings,

• Leash (if snowboarding). • Poles (if skiing)

First timers should take some time to speak with one of the leaders that snowboards or skis to make sure they have all their bases covered or if they don’t know what one of the listed items is, they can also help you to save some mula cause this sport aint cheap! Again these are only suggestions as to what will be needed.

What to Bring: • Bible • Note book and pens • Highlighter • Camera – batteries and stuff • Backpack (optional but nice to take a jacket in) • Book-light • CD Players and CD’s are ok but NO I-PODS! • Games (appropriate) • Sleeping bag • Pillow (s) ? • $ - Suggested Spending $ : about $30.00 (lunch on the ride

up and any snack you purchase along the way will be out of your pocket.) Also there is a snack shack at camp.

• $25.00 for Sledz if you are going.

Clothes: Warm Everything!

• Essentials: Shirts, Pants, Socks, Unders, Shoes • Jacket (snow jackets are best but not necessary)

• Sweatshirt (keep in mind you will be given a sweatshirt at the beginning of the retreat)

• Snow Pants (if you have them, not a must if you don’t) • Sweat Pants (warm for sleeping in) • Boots (?) • Gloves • Beanie • Toiletries & Towel – (Leave the long make-up process at home) • Earmuffs?? • Snow Boarding Gear: (see snowboarding page in retreat

packet for a complete list) LUGGAGE: 1 – Sleeping bag – in garbage bag labeled (your name)

1 – Bag for clothes and toiletries – remember we are only there for 4 days!

1 – Carryon – backpack size for things you want while traveling.

Reverence Bible Church General Release of Liability

2018 - 2019

As a Christian group, we seek to follow the biblical mandate, which disallows bringing charges against Christian brothers in civil courts. We also seek to be good stewards of the resources and blessings that the Lord has provided. Our group has never had an instance of injury of damages being charged to the group. Yet we believe it is best to be sure all members understand our position prior to any mishaps. We are an organized non-profit church group. The leadership is made up of those who have volunteered their time to organize activities for the group. Participation in any event is strictly voluntary, with no member ever being required to attend any meeting or event. Neither our group, nor its leaders, nor its members are liable for any injuries or damages, whether connected with Reverence Bible Church event or not. At every event, parents are responsible for their own children. Children are never allowed to attend any function without a parent. Occasionally a member will desire to send his child (ren) to an activity with another adult member. This practice is discouraged, yet because we understand that occasionally the parent must remain home because of illness in the family, pregnancy, etc., and because of the family-like nature of our group, we do not desire to prohibit it under all circumstances, In any case, no child is allowed to attend any event without being accompanied by and supervised by his own parent or, in special cases, accompanied by and supervised by an adult member designated by that child’s parent to take complete responsibility for him. We suggest that if you find it necessary to send your child to an event with another adult, it be one who is comfortable enough with your child to correct him if necessary. Any special guests (grandparents, relatives, out-of-town friends, etc.) who accompany members to any event are under the sole responsibility of that member for behavior, damages, injuries, etc. It is expected that any member or his child or guest who damages property or who causes injury, either willfully or through neglect, will take personal responsibility for his actions. However, our group will not be involved in any way in such situations. Any person, whether member or not, who has such a claim will be directed to discuss the offense individually with the part he believes to be responsible. The outcome of such a problem is out of the realm of this group’s responsibility. If such disputes cannot be handled by the parties individually, we will expect that they will follow the guidelines of Matthew 18: 15 - 35 thorough their own churches and church leadership. In the remote event of a catastrophe injuring members while at a group event, we require a MEDICAL RELEASE FORM for each child to be signed and on file. (one copy with the secretary and one in the field trip/event packet which we will attempt to have on hand at every event.) No child may participate in any activity without such a form being filled out and signed by the child’s parent/guardian first. I have read the above and agree to hold Reverence Bible Church harmless in the event of any damages or injuries to me, to my children, or to my property.

_______________________________ _________ __________________ Childs Name (Printed) Age Date

________________________________________ __________________ Parent/Guardian Signature Date

________________________________ _________ __________________ Self Signature (18 and over) Age Date

__(____)________________________ __(____)_________________________ Parent/Guard Emergency Cell Phone Number Parent/Guard Emergency Home Phone Number

Reverence Bible Church, Facedown Youth Ministries Special Activity Release of Liability

For Winter Retreat 2018 – Mammoth Lakes, CA

As a Christian group, we seek to follow the biblical mandate, which disallows bringing charges against Christian brothers in civil courts. We also seek to be good stewards of the resources and blessings that the Lord has provided. Our group has never had an instance of injury of damages being charged to the group. Yet we believe it is best to be sure all members understand our position prior to any mishaps. We are an organized non-profit church group. The leadership is made up of those who have volunteered their time to organize activities for the group. Participants Name:____________________________‘s participation in any event, including but not limited to: skiing, snowboarding, sledding, snow sliding, ice skating, snow play, snow throwing, hiking, games, horseback riding, sledding, dog sledding, or bob sledding, is strictly voluntary, with no member ever being required to attend any meeting or event. Neither our group, nor its leaders, nor its members are liable for any injuries or damages, whether connected with Reverence Bible Church Facedown Youth Ministries Retreat events or not. However, care will be sought out for any injuries that may be sustained in the event of an accident. I have read the above and agree to hold Reverence Bible Church and leaders harmless in the event of any damages or injuries to me, to my children, or to my property.

________________________________________ __________________ Parent/Guardian Signature Date

________________________________________ __________________ Parent/Guardian Signature Date

________________________________________ __________________ Self Signature (18 and over) Date

Reverence Bible Church Medical Release

2018 - 2019

Name of Child Birth Date:

Date of last Tetanus booster

Health problems, medical or food allergies:

Name of Child Birth Date:

Date of last Tetanus booster

Health problems, medical or food allergies:

Name of Child Birth Date:

Date of last Tetanus booster

Health problems, medical or food allergies:

Name of Child Birth Date:

Date of last Tetanus booster

Health problems, medical or food allergies:

Name of Child Birth Date:

Date of last Tetanus booster

Health problems, medical or food allergies:

I (We) the undersigned parent, parents, or guardians of the minor child(ren) named above, do hereby authorize and consent to any X-ray examination,

anesthetic, medical or surgical diagnosis and treatment and emergency hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act and on the staff of any acute general hospital bolding a current license to operate a hospital from the State of California Department of Health Services. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority to render care, which the

aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that every effort shall be made to contact the undersigned prior to rendering treatment to the patient(s), but that any of the above treatment will not be withheld if the undersigned cannot be reached. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. The undersigned also assumes the responsibility for any of the

costs connected with such treatment and hereby releases the leaders and members of Reverence Bible Church from any liability therefore. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under any emergency circumstances in my absence.

_______ Parent/Guardian Signature Date

_______

Parent/Guardian Signature Date

Home phone number Emergency Phone/Pager

Address

City State Zip

Physician’s Name Phone Number

Insurance company and policy #

 

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  Medical Information

DATE OF CAMP______________

CAMPER/GUEST INFO: NAME__________________________________________________________________________ AGE______ DATE OF BIRTH______________ Print Last Name First Name ADDRESS_____________________________________________ CITY__________________________ STATE__________ ZIP_____________

HOME PHONE (___)________________ _ CELL PHONE(___)________________ E-mail_____________________ O Male O Female

PARENT/GUARDIAN INFO: NAME(S)________________________________________________________________________________________

ADDRESS____________________________________________ CITY____________________________ STATE__________ ZIP____________

HOME PHONE (___)______________________ FAX NUMBER (___)_____________________ MOTHERS WORK PHONE (___)_______________ FATHERS WORK PHONE (___)_______________ MOTHERS CELL PHONE (___)_________________ FATHERS CELL PHONE (___)_________________

If parent/guardian cannot be reached in case of emergency, please contact: NAME_______________________________________________ RELATIONSHIP TO CHILD__________________________ PHONE (___)_______________

INSURANCE INFO: NAME OF INSURANCE COMPANY________________________________________________ PHONE (___)__________________________ ADDRESS______________________________________________________ POLICY #___________________________ GROUP #__________________________________ EFFECTIVE DATE________________ POLICY SUBSCRIBER__________________________________________ SUBSCRIBER’S BIRTHDATE___________________ SUBSCRIBER’S ADDRESS_________________________________________________________________________________ SUBSCRIBER’S PHONE (___)___________________________ FAMILY DOCTOR___________________________________ PHONE (___)_______________ ADDRESS_________________________________

HEALTH HISTORY: Please check if camper/guest has experienced any of the following: ___Hemophilia/Bleeding Disorder ___Anxiety ___Hypertension ___Hepatitis/Liver Disease ___Kidney Disease ___Mitral Valve Prolapse

___Asthma/Other Respiratory Disease ___Physical Handicap ___HIV/AIDS ___Heart Condition ___Sleep Walking ___Ear Infections

___Epilepsy/Seizure Disorder ___Ulcer/Stomach Disease ___Bowel Disorder ___Rheumatoid/Lupus ___Rheumatic Fever ___Behavior/Nervous/Mental Disorder ___Diabetes ___Bed Wetting ___Other If any of the above are checked, please give details (i.e. include normal treatment/symptoms of allergic reactions, etc.)____________________ __________________________________________________________________________________________________________________________________________________________________________________________

List all previous surgeries:_______________________________________________________________________________________________ ____________________________________________________________________________________________________________________

List all allergies:_______________________________________________________________________________________________________ _____________________________________________________________________________________________

Does camper have any allergic reactions to the following: Bee Stings Hay Fever Poison Ivy Poison Oak Poison Sumac Peanuts Other____________________________

Non-Prescription and Prescription Drugs: Parents and/or legal guardians are required to disclose any medication your child is taking. The Station requires all campers and visitors disclose any medication they are taking. Written physician’s directions should accompany any prescription medicines sent to camp, and should be in the original container, labeled by pharmacist. These directions must include: medication, dosage, frequency, condition being treated, physician’s signature and DEA number. (If your child requires an Epipen for allergic reactions, he/she must have it on their person at all times.) (THE STATION staff will distribute meds, but camper must administer it themselves.)

Name, dosage, and frequency of any medications that must be taken regularly or as needed:__________________________________________

 

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__________________________________________________________________________________________________________________________________________________________________________________________

Date of last tetanus shot:___________________

Any swimming restrictions: Yes__ No__ Any activity restrictions: Yes__ No__ If yes, what restrictions?_________________________________________________________________________________________________    

MEDICAL  RELEASE:  I,  ____________________,  hereby  give  my  permission  to  the  medical  professional  selected  by  The  Station  to  hospitalize,  to  secure  proper  treatment  and/or  order  an  injection,  anesthesia,  or  surgery  for  myself  as  deemed  necessary.    I  also  understand  that  The  Station  staff  is  certified  in  basic  First  Aid  and  CPR,  and  authorize  staff  to  administer  these  skills  if  necessary  for  illness  or  injury.    This  form  may  be  copied  and  given  to  The  Station  staff/volunteers  and/or  medical  personnel  if  there  is  information  pertinent  to  care.        

I  understand  that  I  am  financially  responsible  for  any  amount  not  covered  by  my  insurance  contract.    I  also  authorize  you  to  release  to  my  insurance  company  information  concerning  health  care,  advise,  treatment  or  supplies  provided  to  myself  while  attending  The  Station.    This  information  will  be  used  for  the  purpose  of  evaluating  and  administering  the  claim  of  benefits.    A  photocopy  of  this  authorization  shall  be  considered  as  effective  and  valid  as  the  original.        

Guest  Signature  ___________________________________________________  Date_____________________             (You  may  sign  your  own  release  if  you  are  18  or  older)    

Print  Name______________________________________  Spouse’s  Name_______________________________                  

 

Registration  Form             DATE  OF  CAMP___________  

CAMPER  NAME____________________________    BIRTH  DATE___________      AGE__________    MALE/FEMALE  (circle  one)      GRADE_________      CHURCH/ORGANIZATION____________________    ADDRESS______________________________________________________________________    CITY______________________________      STATE___________________      ZIP_______________    EMAIL  ADDRESS______________________________    Parent/Guardian  Info:    PARENT/GUARDIAN  NAME(S)__________________________________________    ADDRESS  (if  different  than  above)______________________________________________________    HOME  PHONE(___)_______________      CELL  PHONE(___)_______________          WORK  PHONE(___)_______________      EMAIL  ADDRESS________________________________    I  authorize  the  staff  at  The  Station  to  act  for  me  according  to  their  optimum  judgment  in  any  emergency  necessitating  medical  attention,  and  I  waive  any  and  all  claims  for  personal  injury,  illnesses  and/or  property  damage  that  I  may  have  against  The  Station,  and  its  employees,  directors,  contractors,  and  every  volunteer  in  any  way  associated  with  The  Station.    I  understand  that  involvement  in  snowboarding,  skiing,  snowshoeing,  cross  country  skiing,  walking,  hiking,  rock  climbing,  backpacking,  mountain  biking,  swimming,  wake  boarding,  horseback  riding,  and  all  other  camp  activities  involve  the  risk  of  injury  and/or  death,  and  I  authorize  my  child  to  participate  in  such  activities.    I  agree  that  The  Station  is  not  liable  for  personal  items  that  are  stolen,  lost,  or  damaged.    All  medical  expenses  acquired  will  be  the  responsibility  of  the  camper  or  the  camper’s  family.    I  have  no  knowledge  of  any  physical  or  mental  impairment  that  would  be  affected  by  my  child’s  participation  in  the  camp  program.    I  also  grant  to  The  Station,  and  any  third  party  authorized  by  The  Station,  the  right  to  film,  videotape,  photograph,  and  record  the  voice  of  my  child  for  promotional  purposes.          __________________________________________      ____________  Parent  or  Guardian  Signature            Date                I  agree  not  to  take  unreasonable  risks  while  participating  in  snowboarding,  skiing,  snowshoeing,  cross  country  skiing,  walking,  hiking,  rock  climbing,  kayaking/canoeing,  backpacking,  mountain  biking,  swimming,  wake  boarding,  horseback  riding,  and  all  other  camp  activities,  including  causing  anyone  else  unreasonable  risk  of  harm.    I  also  agree  to  follow  correct  safety  procedures,  to  respect  The  Station  staff/volunteers,  my  peers,  and  the  rules  established  at  The  Station.    I  also  grant  permission  for  The  Station,  and  any  third  party  authorized  by  The  Station,  the  right  to  film,  videotape,  photograph,  and  record  my  voice  for  promotional  purposes.      ________________________________________      _____________  Camper  Signature                                      Date