(2,1) -22-23- March Roster Update.indd 3/1/2010 2:03:03 PM
Southwest Region Annual Cluster Campout June 11 - June 13 Pine Lake Campground Directions: Travel 13 miles east on Utah State Highway 12 from the junction at Hwy 89. Then travel 11 miles north on John’s Valley Road (#22). Then head east for 6 miles on Clay Creek Road (#132) .
Deadline for Registration is June 1, 2010 Name: Address: City/State/Zip: Phone: # of people in your family: We will be staying Friday night (free) Yes
No
We will be staying Saturday night (free) Yes
Please note: -No electricity hookups -There is running water and clean toilets -Families are responsible for their own food and drinks, except for Saturday’s lunch -Pine Lake Campground accommodates trailers or RVs up to 45 feet -Pets must be leashed -No discharge of fire arms or fireworks -Unloading access for OHV trails is available -All terrain and OHV are NOT allowed in the campground
No
We will need a spot for a Tent
Trailer
We will attend Saturday’s event ONLY (free) Yes No I am... Resource Parent Kinship/Specific
Adoptive Parent DCFS
Licensing
Utah Foster Care Foundation would like to remind you that there is a small lake and all the little hazards of camping at this outing. We would like to remind you to supervise and use all safety precautions with the children in your care. The Foundation is not responsible and cannot be held liable for any accidents that occur.
Signature: Please send this form to Diane Callister, Southwest Region Retention Specialist 321 N. Mall Dr. #B102 St. George, UT 84790 OR fax to 435-656-8071
23