youth rally and mission flyer - clover...
TRANSCRIPT
Time to register for the 2017 Youth Rally and Mission Trip! We know that God has some great things planned for Aftershock this year. The costs are going up but we have worked out a great
deal to try and help our families this year along with lots of fundraising opportunities.
We are back with Group Mission Trips Weekend Workcamp for our trip. We will be heading to Scranton, PA from 6/23-6/26. The remaining balance after deposit will only be $249 with no
payment until March for plenty of time to sell 10 stocks to cover the remaining payment.
INDIVIDUAL REGISTRATION Event Cost # of Youth/Adult Total
Youth Rally $120 (Early Bird) $130 (Non-Early Bird) x ______ = ______
Mission Trip $60 deposit x ______ = ______
Both (YR+MT) $170 (savings of up to $20) x ______ = ______
TOTAL: ______ MULTIPLE REGISTRATIONS (same household)
Event Cost # of Youth/Adult Total
Youth Rally $110 (Early Bird) $120 (Non-Early Bird) x ______ = ______
Mission Trip $50 deposit x ______ = ______
Both (YR+MT) $150 (savings of up to $20) x ______ = ______
TOTAL: ______
Friday, June 23 – Monday, June 26
Early Bird and Mission trip registration is Oct. 2nd
Additional registrations:
Youth Name:
Medical Form: □ Youth Group □ Youth Rally
Grade:
6th / 7th / 8th / Freshman / sophomore / junior / senior
Gender: □ male □ female
Attended in past: □ Youth Rally □ Mission Trip
Parent Email:
Payment: □ check (# ) □ cash Amount:
Checks Made payable to: Gethsemane UMC
Return forms and $ to Jordan 302-448-5328 or [email protected]
Youth Name:
Medical Form: □ Youth Group □ Youth Rally
Grade:
6th / 7th / 8th / Freshman / sophomore / junior / senior
Gender: □ male □ female
Attended in past: □ Youth Rally □ Mission Trip
Youth Name:
Medical Form: □ Youth Group □ Youth Rally
Grade:
6th / 7th / 8th / Freshman / sophomore / junior / senior
Gender: □ male □ female
Attended in past: □ Youth Rally □ Mission Trip
Youth Name:
Medical Form: □ Youth Group □ Youth Rally
Grade:
6th / 7th / 8th / Freshman / sophomore / junior / senior
Gender: □ male □ female
Attended in past: □ Youth Rally □ Mission Trip
GETHSEMANE UNITED METHODIST CHURCH YOUTH MINISTRY
2016-2017 Emergency Medical Information
Personal Information Participant's Name: _____________________________________ Date Of Birth M/D/Y ____/_____/____
Home Address: _________________________________________ Home Phone: (_____) ______________
City/State/ Zip: _________________________________________
Parent/Guardian Name(s): _______________________________________________
Mom's Cell Phone #: ________________________________ Mom's Work #: (____) _________________
Dad's Cell Phone #: __________________________________ Dad's Work #: (____) __________________
Medical Information
Any current medical conditions or problems? If so, describe:_______________________________________ _________________________________________________________________________________________ Any allergies?_____________________________________________________________________________ Taking any prescribed medication? ____________________________________________________________ Past medical history/injuries we should be aware of: ______________________________________________ Date of last Tetanus shot:____________________________________________________________________ Name of physician: _____________________________ Phone #: ___________________________________
Insurance Information Group Or Family Hospitalization Insurance Company: _________________________________________________ Insurance Company's Address: ____________________________________________________________________ Agent's Name: ___________________________________________ Phone #: ______________________________ Group#: ________________________________________________ Policy #: ______________________________ In Case Of EMERGENCY (If Parent Can't Be Reached) Call: ___________________________________________ Day Phone Number: _____________________________________ Night Phone #: __________________________
Waiver of Responsibility
I, , legal parent or guardian of __________________ give my permission to him/her to go on all camps, trips, & retreats, and to participate in all activities for the 2016-2017 school and summer. I hereby release the church, its staff, and volunteer counselors of any liability in the event of accident or injury. Signed: ________________________________________ Date: ______________
Gethsemane United Methodist Church Youth Group
PHOTO/VIDEO RELEASE FORM (UNDER 18 FORM)
I, _________________________________________________, GRANT/DO NOT GRANT (please circle)
permission to the Gethsemane United Methodist Church Youth Group to use, reproduce and communicate the
photographs and videos taken of my child _______________________________(name) at all GUMC Youth
Group gatherings, social and spiritual activities and camps for the purposes of GUMC Youth Group
publications (e.g. Promotional Youth Group Videos, Newsletters, GUMC Youth Group social media group
pages, etc.).
I also, GRANT/DO NOT GRANT (please circle) permission to the Gethsemane United Methodist Church
Youth Group for my child’s name to be published alongside any photographs that are released.
I understand that I am entitled to request the withdrawal of any photographs that I do not want to be published
of my child, and sign a new form if I change my mind about general permission for publication of photographs
of my child. Thank you for your assistance.
Signed: ........................................................................... Date: ........................................
I would not like my child’s photographs/videos to be published in the following (please circle):
GUMC Aftershock promotional videos
GUMC Aftershock Facebook/Twitter/Instagram group page
(If you choose to not grant permission, please have a conversation with your child(ren) about why you have
made that decision. This way they can be aware enough to step out of group photos without drawing attention
to themselves because someone has to ask them to step out of the photo. Thank You.)