Fall Retreat Registration

Mini Methodist & Youth Fall Retreat.jpg
 

Calling all Youth M & M’s! It’s time for a Fall Overnight Retreat at Birchwood Camp!


LOVE WELL


Join us for a weekend of faith, fun and fellowship as we explore how we can Love Well. Please fill out the form below or contact the St. John office at (907) 344-3025 for more info.

 

Saturday, August 31st – Sunday, September 1st
M & M’s (5th & 6th grade) and Youth (7-12th grade) will be enjoying the camp together. There will be a joint activity and worship; sessions and cabins will be set up by ages. This is a must-do retreat! Friends are invited to join us as well! We will depart St John at 9:00am on Saturday to head out to Birchwood Camp. We will return to St John to worship together for the 9:15am service. Pick up will be at St John at 10:15am.

**Great opportunity for parents to fill their soul with the inspiration of children & youth! We will need parents to help drive youth and children to and from Birchwood Camp and also will need 8 males and 8 females to chaperone. Contact Erynne or Robbie today for this amazing opportunity!**

Registration Deadline: August 20.
Cost: $75
*Scholarships are available, please talk to Erynne or Robbie.

Packing List

  • Bible

  • Writing Utensil (Pen or Pencil)

  • Journal

  • Flashlight/headlamp

  • Change of Clothes (please be mindful of weather conditions and pack appropriately)

  • Extra Socks (just in case yours get wet)

  • Personal toiletries

  • Sleeping Bag & Pillow

  • NO electronics or food (please and thank you)

  • Great attitude :)

Child/Youth's Name *
Child/Youth's Name
Birthdate *
Birthdate
Gender *
Child/Youth's Name
Child/Youth's Name
Birthdate
Birthdate
Gender
Parent/Guardian Name *
Parent/Guardian Name
Address
Address
Primary Phone Number *
Primary Phone Number
Secondary Phone Number *
Secondary Phone Number
Additional Parent/Guardian Name *
Additional Parent/Guardian Name
or other Emergency Contact
Primary Phone Number *
Primary Phone Number
Secondary Phone Number *
Secondary Phone Number
Physician's Phone
Physician's Phone
Full Name of Insured
Full Name of Insured
Please indicate youth/child's name (if registering more than one youth/child)
Please indicate youth/child's name (if registering more than one youth/child)
Check Box Below to Agree to Media Release *
I, Parent/Legal Guardian of (child’s name listed above), hereby grants permission to St. John UMC, its agents and assigns, to use above named youth/child’s photo or video, and likeness for the purpose of promotion by St. John UMC for all forms, media and manners, for the following, but not limited to, news releases, photographs, video, audio, website/social media, marketing, advertising, trade, promotion, exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings of the youth/child’s to be used in print, video, digital and internet media. I agree that these images and/or voice recordings may be used for a variety of purposes and that these images may be used without further notifying me. I further acknowledge that I will not be compensated for these uses and that St. John UMC owns all rights to the images, videos, and recordings, and to any derivative works created from them. I waive any right to inspect the uses of any printed or electronic copy. I hereby release St. John UMC and its agents and assigns from any claims that may arise from these uses, including without limitation claims of defamation or invasion of privacy, or of infringement of moral rights or rights of publicity or copyright. This Release expresses the complete understanding of the parties.
Check Box Below to Agree to Code of Conduct *
Code of Conduct As the parent/legal guardian of this registered youth/child(s), I agree on our behalf: To abide by the Covenant of Conduct In all meetings, retreats, or other events under the sponsorship and/or guidance of my church, I am a representative of that Christian community and I am responsible for my actions. St. John Leadership/Birchwood has my/our permission to attend and participate in the 2019 Fall Retreat at Birchwood Camp. Please seek any medical assistance while this child is with St. John United Methodist Church. We hereby grant permission to St. John UMC, its agents and assigns, to use above named youth/child's photo or video, and likeness for the purpose of promotion by St. John UMC for all forms, media and manners, for the following, but not limited to, news releases, photographs, video, audio, website/social media, marketing, advertising, trade, promotion, exhibition for an indefinite period of time. I give unrestricted permission for images, videos, and recordings of the child to be used in print, video, digital and internet media. I further acknowledge that I will not be compensated for these uses and that St. John UMC owns all rights to the images, videos, and recordings, and to any derivative works created from them. I waive any right to inspect the uses of any printed or electronic copy. I hereby release St. John UMC and its agents and assigns from any claims that may arise from these uses, including without limitation claims of defamation or invasion of privacy, or of infringement of moral rights or rights of publicity or copyright. This Release expresses the complete understanding of the parties. I/We have read and understand the above document. By signing this document I/We hereby release St. John United Methodist Church, from any and all liability for personal injury or damage to property.
Please indicate youth/child's name (if registering more than one youth/child)
Myself and my youth/child(s) understand that they will be abide by the Responsibilities and Guidelines established by Birchwood Camp, and St. John United Methodist Church. *
Please check one
I can help chaperone
I can help drive to/from
Date Signed *
Date Signed