Weekend Consent & Medical Form In the event that your child becomes ill or is injured, we request that Young Life be given permission to take your child to the nearest medical facility or healthcare provider and have the necessary treatment administered. Your signature below will acknowledge your acceptance and understanding of Young Life’s role in the medical care of your child. In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Young Life the permission to act in my behalf in seeking emergency treatment for my child in the event that Young Life deems such treatment necessary, I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I absolve Young Life from liability in acting on my behalf in this regard. I hereby grant permission to Young Life to use, reproduce, and/or distribute photographs, film, video, and sound recordings of my child without compensation or approval rights, for use in materials created to promote Young Life. Name of child_______________________________ Parent/Guardian_____________________________ Signature of Parent/Guardian_____________________________ If above not available, please call person listed below: Name_____________________________________ Relation ___________________________________ Phone Number______________________________ Address___________________________________ City _______________________________________ State _____________ Zip ___________________ Additional comments regarding medical history, allergies, penicillin or drug reaction, etc., which may be needed in any treatment: ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Insurance Company_______________________ Policy Number ___________________________ Young Life covers all injury claims that are less than $250. Any claim exceeding $250 will be coordinated with your personal insurance entirely. At that point, Young Life will become the secondary carrier and will supplement your coverage. The maximum amount of coverage available from Young Life is $4,000. A note to parents… Young Life is getting ready again to head off for a super weekend at one of its resorts for high school students. Since your son or daughter is interested in attending, you may be wondering, “What is its purpose?” and “who is behind it?” This brochure will answer some of those questions. Our leaders and committee will be glad to answer any other questions you may have. Young Life knows it has something to offer your son or daughter to help them make sense of the world's clamor. Our goal is to introduce kids to a meaningful relationship with God. Young Life can be that friendly voice of encouragement that kids need today. Behind Young Life stands a responsible Board of Directors made up of men and women from many different churches representing every part of the United States. In each community where Young Life is active, there is a group of interested adults who sponsor and promote the work locally. They also assume the responsibility for the support and personnel. These groups are called local committees and sender teams. Todd and Melena Madonna Tom and Shelly Anderson Mike and Sharon Bennett Scott and Claudia Fonda David and Penny Gerrard Josh and Daisy Isler Bill and Patty Sohl Melissa Sohl Jackie Stancato 610.918.2561 610.458.9780 610.857.4323 610.594.6827 610.937.1474 610.647.3115 610.458.0647 610.639.2199 610.368.8017 Wreath Fundraiser You can make $8 toward camp on every wreath that you sell! These are beautiful 24” wreaths priced at $25. Your leader has brochures to assist your sales. Collect money with order. Checks should be made out to “Young Life”. th Last day for orders is November 13 . Delivery nd will be the afternoon of December 2 . WINTER WEEKEND 2015 January 16-19 @ Lake Champion Glen Spey, NY Chester County CCYL - WW2015 Registration Form YOUNG LIFE NAME ________________________________ WINTER WEEKEND ADDRESS ____________________________ ______________________________________ CITY _________________________________ 2015 ZIP CODE ____________________________ PHONE NUMBER ______________________ January 16-19 EMAIL _______________________________ Want to get away for a great weekend? Here’s your chance! You will have a great time with friends while skiing, snowboarding, and all the other things Lake Champion has to offer. You will start new friendships that will last a lifetime and discover purpose in life that's more than just “getting by." Come join us for an incredible weekend! PARENTS’ EMAIL _______________________ SCHOOL _____________________________ GRADUATION YEAR ___________________ PARENT/GUARDIAN NAMES ______________________________________ PARENT/GUARDIAN SIGNATURE How to sign up: ______________________________________ What to bring: To save your spot at WW2014, fill out the registration form (front and back), tear off, and give it to your leader or mail it in to the Young Life office with a $50 deposit (include additional $15 if you need to rent skis or snowboarding equipment) Deposit is nonth refundable after January 5 , 2015. ~Warm clothing and spending money for the snack shop and camp store. ~Paper bag dinner Friday night ~Money for Saturday dinner at the ski slope ~Money for fast food lunch Monday. *All other meals are included* **The camp provides linens and towel** The Cost: Without Ski Rental With Ski/Snowboard Rental $220.00 $235.00 Price includes transportation, lodging and all the meals and activities at camp. The lift ticket is included but you will need to include $15 with your deposit if you need to rent skis or snowboarding equipment. Trips leave at 5:00pm on Friday. Return around 4pm on Monday. CELL PHONES will be collected at the start of camp and returned for the ride home. Use the contact information below for Lake Champion communication. Young Life of Chester County P.O. Box 3029 West Chester, PA 19381 610.344.7330 [email protected] chestercounty.younglife.org Young Life’s Lake Champion 247 Mohican Lake Road Glen Spey, NY 12737 (845) 856-6871 www.LakeChampion.YL.org PLEASE CHECK ONE: I need to rent skis or snowboarding equipment. I have included my $15 rental fee along with my $50 deposit ($65 total). I do not need to rent skis or snowboarding equipment. I have included my $50 deposit. Please make all checks payable to Young Life and mail to: Young Life of Chester County P.O. Box 3029 West Chester, PA 19381 (Complete BOTH sides of reg. form & rip off) Payments can be made directly through the YL website giving.younglife.org/payments FUNDRAISER available – ask your leader!
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