June 20th - 25th, 2016

What is Journey Quest?Journey Quest is our rite of passage trip for students who are seeking to go deeper in their walk with Christ and are wanting to learn more about growing in leadership. Journey Quest is a Christian Wilderness Ministry that will take us on a 6 day rafting trip this summer. Led by trained guides, students will participate in a wilderness camping experience in which they will learn to follow and to lead through several challenges. One of our challenges will be reading and discussing a book. This summer’s book is “A Call to Die” By David Nasser. Who can go?Journey Quest is for students who have completed at least the 7th grade, are regular attendees of our student ministry and small groups, who have a relationship with Jesus Christ, and who have a desire to grown deeper in their faith.

What is the cost?The cost for Journey Quest is $260 per student plus money for meals on the way to and from Colorado and any souvenirs students may wish to buy.

What is the deadline to register?In order for us to inform Journey Quest of our group number, we will need to have all student interview forms and a $50 deposit turned in NO LATER THAN SUNDAY, MAY 1st. Beyond this point, our group will be penalized financially for any changes we make to our number. We need all other forms (health, physical and release forms) and remaining balance turned in NO LATER THAN SUNDAY, JUNE 12TH. We will need time to get all the forms ready before we leave.

Right of Passage: Rafting & Rock Climbing

Every student desiring to attend Journey Quest must be personally interviewed by Pastor Andrew. This interview is a part of your registration.

1. Is Jesus Christ your personal Lord and Savior? q Yes q No On the back of this sheet or on another sheet of paper, please write out your testimony regarding Jesus coming to be your Lord and Savior. Use the following outline:

Describe your life before Jesus became your Lord and Savior. Describe when and how Jesus became your Lord and Savior. Describe your life since Jesus became your Lord and Savior and how you are different as a result.

2. How often do you attend the activities and programs of our church? (Estimate your attendance with: W=weekly, O=often, S=seldom, and N=never.)

_____ Sunday mornings _____ Small Groups _____ Camps and Retreats

_____ Sunday evenings _____ Fellowship activities _____ Other:_____________________

3. In what positive ways do you influence individual members of:

❖ your family:__________________________________________________________________________

___________________________________________________________________________________

❖ the LABC student ministry:______________________________________________________________

___________________________________________________________________________________

❖ your friends at school:_________________________________________________________________

___________________________________________________________________________________

4. What are you currently doing on a daily basis to grow deeper in your relationship with Jesus Christ?

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

5. Check any of the following activities you do daily or with some degree of regularity:

_____ Read my Bible _____ Witness of lost friends _____ Pray

_____ Have a quiet time _____ Memorize scripture

6. What is compelling you to go on this mission trip? What do you hope to learn about missions?

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

By signing my name, I understand that my church family is sending me on this trip. Many people have invested a great deal because they care for my spiritual growth. I agree to take seriously this great opportunity to grow as a Christian on mission. I will not waste this opportunity.

_____________________________________ _____________________________________ ___________________ Your Signature Your Printed Name Date Signed

2016 Student Interview

Par

tici

pan

t

Participant’s Name (First, Last)

Emer

gen

cy

Con

tact

Name (First, Last)

Address Relationship to Participant

City, State, Zip Primary Phone Secondary Phone

Email Address

Med

ical

C

onta

cts

Family Physician’s Name

Primary Phone Secondary Phone Primary Phone Secondary Phone

Birth Date (MM/DD/YYYY)o Male o Female Health Insurance Company

Group or Trip Name Insurance Company’s Phone Insurance ID Number

Hea

lth

His

tory

Have you previously or do you currently have:(Circle Yes or No)

YES NO - Heart ProblemsYES NO - Low or high blood pressureYES NO - Allergies (drugs, bees, etc.)YES NO - Asthma (please note if you carry an inhaler.)YES NO - Back problemsYES NO - Recent sprains, fractures, or dislocationsYES NO - Knee problemsYES NO - Dizziness, fainting spellsYES NO - Severe abdominal or menstrual crampsYES NO - Frostbite, hypothermiaYES NO - Emotional impairment or disabilityYES NO - DiabetesYES NO - Dietary restrictionsYES NO - Thyroid troubleYES NO - Current communicable diseasesYES NO - Epilepsy, seizures, or convulsions

Please explain any items circled YES for any condition, injury, or illness requiring medical treatment that might restrict or prevent full participation in the program:

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

Are you currently pregnant? YES NOAre you presently using any medicines, alcohol, or drugs? YES NODo you have special dietary needs? YES NO

Immunizations: List the most recent date, if any: Date DateTetanus _____________ Hepatitis A _______________MMR _____________ Hepatitis B _______________

This section must be completed for all participant’s under the age of 18

Fath

er /

G

uar

dia

n

Name

Mot

her

/

Gu

ard

ian

Name

Address if Different Address if Different

City, State, Zip City, State, Zip

Primary Phone Secondary Phone Primary Phone Secondary Phone

Con

sen

t fo

r

Trea

tmen

t

I authorize the staff of Journey Quest to give consent to emergency examinations and/or diagnostic procedures, procurement of medical treatment, emergency surgery, or administration of necessary anesthetics, when in the opinion of any physicians or surgeon of good standing such medical treatment is deemed necessary for the mental or physical health of the participant and I/we cannot be reached within a reasonable time to obtain my/our consent to treatment. This grant of authority shall not create an independent duty on the part of Journey Quest’s employees to give consent to treatment.

Signature of Parent or Legal Guardian: Ö ____________________________________________ Date: _____________

-- Please complete release form on the next page -- Page 1 of 2

Use this form for overnight trips. Please print neatly and complete both pages of this form. We recommend that you keep a

photocopy of this completed form for your records.

Health & Release Form

Use this form for overnight trips.

Agreement, Acceptance of Responsibility, Release and Discharge and Acknowledgement of Risks

Parent’s or Legal Guardian’s Additional Indemnification (Must be completed for each participant under the age of 18)

In consideration of ___________________________ (print Minor’s name) being permitted by JQ to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless JQ from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

Signature of Parent or Legal Guardian: Ö ____________________________________________ Date: ____________________

Have you completed the health form on the previous page? Page 2 of 2

Health & Release Form

In consideration of the services of Journey Quest, Inc., its officers, agents, employees, representatives or all other persons or entities acting in any capacity on its behalf (herein referred to as JQ), I hereby agree to release and discharge JQ, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate as follows:

I. I fully understand and acknowledge that the activities, including kayaking, climbing and rafting, in which I am about to engage in as a participant, bear known and unanticipated risks which could result in injury, death, paralysis, or damage to myself, my property, or other third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activities. The risks include, among other things: 1. Rapids can cause participants to be jolted, jarred, bounced, thrown about, or otherwise shaken and participants may come in contact with food boxes, storage containers, other participants or other fixed equipment, 2. Boats may overturn causing: a. exposure to cold water and/or hypothermia; b. injuries sustained from the raft and its supplies and/or equipment or from items in the river bed, such as floating debris or rocks; c. drowning; 3. Participants may be washed overboard which can result in any of the above events occurring, 4. Acts, omissions, or negligence in any degree by JQ, 5. Use or operation, by myself or others, of equipment supplied by JQ, or other persons or entities, 6. Acts of other participants in this activity, or other person or entities, 7. My own physical condition or my own acts or omissions, 8. Condition of roads, trails, waterways, fields or terrain and accidents connected with their use, 9. First aid emergency treatment or other services rendered, 10. Consumption of food or drink, 11. Contact with domestic and wild animals, 12. High altitude, 13. Severe weather changes, 14. Exposure to natural elements, 15. Rock fall, 16. Poisonous plants, 17. Bites or stings, 18. Allergic reactions.

I understand and acknowledge that the above list is not exhaustive, and that other risks, known or unknown, identified or unidentified, anticipated or unanticipated may also result in injury, death, illness, disease, or damage to myself, to my property or to participants. I knowingly and expressly accept those not specifically listed above as well.

II. I fully understand and acknowledge that JQ cannot guarantee my safety. Being fully aware of the aforementioned, I expressly agree and promise to accept and assume all risks from my participation in this activity. My participation is purely voluntary, and I elect to participate despite of the risks.

III. I hereby voluntarily release, forever discharge and agree to hold harmless and indemnify JQ, its agents or employees, US Forest Service, US National Park Service, Colorado Division of Parks and Recreation, BLM, City of Canon City, and all other persons or entities from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of or are in any way connected with my participation in this activity, including specifically but not limited to the negligent acts or omissions of JQ, its agents or employees, and all other persons or entities, for any and all injury, death, illness or disease, and damage to myself or to my property. In signing this document, I fully recognize that if anyone is hurt or property is damaged while I am engaged in this activity, I will have no right to make a claim or file a lawsuit against any of the entities listed above.

IV. Should it become necessary for JQ, or anyone acting on its behalf, to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

V. I agree that any dispute over this agreement will be resolved in the State of Colorado. I agree that the substantive law of that state shall apply in that action. If the dispute can not be resolved by mutual agreement, I agree to submit it to a mediator recognized by the courts of that state.

VI. I certify that I have sufficient health, accident and liability insurance to cover any injury or damage I may suffer or cause while participating in these activities or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in these activities, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly by any such condition.

VII. I grant permission to JQ to use photographs or video footage taken of me, online or in print, for public relations or fundraising purposes.

VIII. Royal Gorge Trips: _______ (Initials) I fully understand and acknowledge that prior class 3 or higher paddling experience and strong swimming ability are recommended for participation in Royal Gorge trips.

My signature below indicates I have read this entire document, understand it completely, understand that it affects my legal rights, and agree to be bound by its terms.

Signature of Participant: Ö ________________________________________________ Date: ______________________________

How did you hear about us? ________________________________________________________________________________________________

lincoln avenuebaptist church

2016 student ministry participationinformation/consent form

GENERAL INFORMATION

Student’s Name: ______________________________________________ DOB: _____/_____/_____ Grade: ____________

Address: ________________________________________________/_______________________________/_____________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Home Phone: ________________________________________ Cell Phone: _______________________________________

PRIMARY PARENT/GUARDIAN INFORMATION:

Name:_______________________________________________________ Home Phone: ____________________________

Address (if different from above): _________________________________________/_________________________/____________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Work Phone: ________________________________________ Cell Phone: _______________________________________

EMERGENCY CONTACTS (individual(s) to whom student may be released if parent/guardian is unavailable)

Contact #1: _________________________________________________ Relationship: _______________________________

Address: ________________________________________________/_______________________________/_____________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Phone= Home: __________________________ Work: __________________________ Cell: _________________________

Contact #2: _________________________________________________ Relationship: _______________________________

Address: ________________________________________________/_______________________________/_____________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Phone= Home: __________________________ Work: __________________________ Cell: _________________________

STUDENT’S MEDICAL CARE AND HEALTH INSURANCE INFORMATION

Physician’s Name: ___________________________________________________ Phone: ____________________________

Address: ________________________________________________/_______________________________/_____________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Hospital’s Name:______________________________________________________ Phone: __________________________

Address: ______________________________________________/______________________________/________________ (Street Number and Name and/or PO Box Number) (City and State) (Zip Code)

Ambulance Service: ____________________________________________ Phone: _________________________________ (Parents/Guardians are responsible for all emergency transportation charges.)

Health Insurance Co. Name: _________________________________________ Plan Name: __________________________

Subscriber’s Name: ___________________________________ Subscriber/Policy ID: ________________________________

*PLEASE ATTACH A COPY OF BOTH SIDES OF INSURANCE CARD TO THIS FORM*

Does the student have any special conditions, disabilities, allergies, or medical emergency information? No Yes

If yes, please explain: ___________________________________________________________________________________

_____________________________________________________________________________________________________

PARENT/GUARDIAN CONSENT TO PARTICIPATION: As a parent/guardian, I consent to the participation of my child in all Lincoln Avenue Baptist Church activities, including, but not limited to: life groups, road trips, Falls Creek, leadership retreat, and mission trips. As a parent/guardian, I consent to have my child receive first aid by church staff and sponsors, and if necessary in the judgment of church staff or sponsors, to be transported for and receive emergency care. I will be responsible for all charges not paid by my insurance. I give consent for the emergency contact person listed above to act on my behalf if I am unavailable. This consent shall remain in effect until revoked by me in writing.

MEDIA PERMISSION/CONSENT: By signing this form as a parent/guardian, I also give permission to Lincoln Avenue Baptist Church to post video/pictures of my child on its various web-based sites for the purpose of allowing parents and students to understand better the mission of Lincoln Avenue Baptist Church. If I do not wish for my child’s picture/video to be posted to the internet for this purpose, I understand I may make my wishes known by sending a signed and dated letter to Lincoln Avenue Baptist Church at: P.O. Box 2704, Woodward, OK 73802.

_____________________________________________ _____________________________________________Parent/Guardian’s Signature Date Parent/Guardian’s Signature Date

Extended River TripsEquipment List / What to Bring

We are delighted to have you on an extended river trip with Journey Quest! The weather can change quickly in the

mountains and river valleys, so it is important to be well prepared for whatever may come. Below is a list of

equipment and clothing we recommend for an extended river trip with Journey Quest:

Clothing Equipment Miscellaneous Waterproof Rain jacket

Fleece or Sweater

(preferably not made of cotton)

2 Swim Suits

(No bikinis or speedos please)

1 Pair of Shorts

1 Pair of Lightweight Pants

(preferably not cotton)

2 Pair of Socks

2 Tee shirts (preferably quick-

drying synthetic, not cotton)

2 Pair Underwear

Brimmed hat

Change of Clothes for Travel

Towel

** Don’t bring anything that will be

ruined if it gets wet! **

Sleeping bag (20-40 degree

rated, synthetic fill, not down)

Sleeping pad (such as a blue

foamy, Ridge-Rest, etc.)

2 water bottles

(to hold 2 or more liters total,

Gatorade bottles are great)

Sandals or Water Shoes

(full-straps, not flip flops)

Hiking or Trail Shoes (something

you don’t mind getting wet)

Camera (we recommend

waterproof cameras or using

waterproof cases)

Flash light or head lamp

Sunglasses

(We recommend inexpensive

sunglasses with a keeper cord)

Optional: Crazy Creek Chair

Bible, pen, and Journal

(In heavy duty ziplock bag)

Sun screen

(Water proof, SPF 30 or higher)

Lip Balm (SPF 15 or higher)

Insect Repellant

Toiletries

(Tooth paste, tooth brush)

Medications you are taking

Optional: Spending Money for

Souvenirs or Snacks

Please Do Not Bring: iPods or MP3 Players

Cell Phones or Video Games

Alcoholic Beverages

Illegal Drugs

Books or magazines

Massive Amounts of Junk Food

(You know who you are…)

Code of Conduct:

Bring along a good attitude and expect to be challenged! The mountains rugged; the rivers rough, but they are

very rewarding. To make you trip as enjoyable as possible for you and the others participants, we ask the following

of each participant:

For your personal and group safety, all participants must follow safety rules set forth by the guides.

We ask all participants to refrain from using tobacco, alcohol, or illegal drugs while on a trip with Journey

Quest. Failure to comply with this policy is grounds for dismissal.

Please refrain from using inappropriate language and course joking. We find it detracts from the experience

and is offensive to most participants.

We ask that you show proper respect to the other participants and guides. This includes listening without

interruption, encouraging those who are struggling, and helping each other.

We also ask that you show proper respect to members of the opposite sex. This includes dressing modestly

and respecting privacy and personal space.

Journey Quest is a Christian ministry and the trip will include devotionals, worship times, and Bible Studies /

Discussions. We expect all to participate in these activities.

Failure to abide by these will result in disciplinary action or, in some cases, dismissal from the trip.

Journey Quest » www.journeyquest.org «

Phone: 719-276-2227 » Toll-Free: 1-888-623-7939

» Office Address: «27077 Highway 50 Suite 4

Texas Creek, CO 81223