Creation 2011 Personal Information: Student’s Name ________________________________________________________ Address_______________________________________________________________ City______________________________ State____________ Zip_________________ Date of Birth (MM/DD/YYYY) __________ / ___________ / ______________________ Parent’s Name(s): ______________________________________________________ Home Phone: ______________________ Student Cell: _________________________ Parent’s Cell(s): ________________________________________________________
Emergency Contact Information: Please indicate who we should contact in the case neither parent is available. Name: ________________________________________________________________ Relationship to Student: ________________________________________________ Contact Information: ___________________________________________________ ____________________________________________________________________
Medical Information: Insurance Provider: ___________________________________________________ Policy #: ______________________________________________________________ Contact Number for above provider: ____________________________________ If your child has a current or past physical or medical condition (including allergic reactions) about which we should be aware, please use the space below to detail any such injury or condition in case of emergency. Please also indicate any medication that your child may be on so that we can properly care to their need should a situation arise. ______________________________________________________________________ ______________________________________________________________________ Please verify the above information and sign here once everything is complete: Parent’s Signature: ___________________________________ Date: ______________
– Photo/Video Permission: As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the internet does not allow us to control who may access such information. These dangers have always existed; however, we as a Church do want to celebrate your child’s work in Christ. The law requires that we ask for your permission to use information about your child. Pursuant to law, we will not and cannot release any personally identifiable information regarding your child without prior written consent from you as a parent or guardian. We would like to post pictures and/or videos on our church’s website (www.secondcapemaybaptist.com) and also on our youth group’s Facebook page. Please check one of the options below. If you have any comments or further instructions, please include them on the space below.
I give my permission to allow the church to post pictures /video of my child. I do not give my permission to allow the church to post pictures of my son/ daughter. ______________________________________________________________________ ______________________________________________________________________
Behavior Contract: Should my child violate any of the rules listed below, I expect to be asked to travel to our retreat location (locations vary) to withdraw my child from the group and return them home. If requested, I will immediately comply with such a request. I understand that any and all inconveniences, hardships, financial and other costs incurred as a result of such action requested by the group leader are to be borne directly upon me. Neither the church, nor trip staff will bear any of the financial cost. In addition to all other possible reasons for dismissal from the trip, for each of the following violation, A Zero Tolerance is the standard. I will be immediately notified and will comply with the request to travel and pick up my child from the trip if he/she violates any of the following rules: 1. Failure to adhere to policies of Second Cape May Baptist Church AT ALL TIMES while under supervision of any trip leader. 2. Possession of, smoking, or other use of tobacco products. 3. Possession of or use of alcohol or any type of drugs. 4. Possession of any kind of pornographic material. 5. Any behavior that we deem a threat to the safety of another member of the group, a staff leader, or any other group member with whom the student has come in contact with. 6. Any attempt to willfully damage any property of another group member or staff member. 7. Presence of boys in girls’ tents. Presence of girls in boys’ tents.
I certify that my child and I have completely read this behavioral contract. ___________ Parent Initial Here
– Waiver of Liability: My son/daughter has had a physical exam within the last two years. As such, I judge him/her to be physically fit to participate in the activities. In the event that my child is injured or requires immediate and/or emergency care and I cannot be contacted, I authorize Pastor Jeff Kammerer to act for me according to his best judgment (including treatment and/or transportation to medical facilities). I also authorize area medical personnel to act on my behalf in the event of an emergency and I cannot be contacted. Furthermore, I understand that participation in youth retreats inherently carry risk of physical injury and even death. I, my child’s heirs, our legal representatives, and other related persons furthermore agree to absolve the Second Cape May Baptist Church, its administration, employees, group leaders and other staff from any liability resulting from an injury or death incurred while participating as a group member in the various activities of SCMBC’s outings and retreats. I also agree to absolve from liability any other organizations - including, but not limited to (Creation Festival and Agape Farm) upon whose facilities or property my son/daughter may travel, or otherwise be involved in scheduled or optional recreational or other retreat activities. I also absolve Second Cape May Baptist Church organization’s employees and the designated group leaders, and other staff from any liability resulting from injury from, damage to - or damage caused by- my child’s use of any equipment found during our retreat.
Please carefully look over all three pages of this packet before continuing. By signing below you acknowledge: Your son/daughter is physically able to participate this trip. Your permission to allow your son/daughter to attend our trip and be under our care. All the above information is accurate and current. Student’s Name: __________________________________________________ Student’s Signature: _____________________________ Date: _____________ Parent’s Name: ___________________________________________________ Parent’s Signature: ____________________________ Date: _______________
Second Cape May Baptist Church – 600 South Shore Road – Marmora, NJ 08223 – www.secondcapemaybaptist.com
CreationFest 2011 For Parents Only Parents, on this sheet you’ll find specific information regarding our upcoming trip to Creation. Our hope is that the information below is beneficial and will answer any question you may have. Where are you going? Creation is an annual Christian music festival located at Agape Farm in Mount Union, Pa. What are you doing? Creation has top Christian bands and speakers from across the country for this festival. How much does it cost? The total price is $150.00. That cost includes the cost of transportation, food, and tickets to the event. There are also many places to purchase snacks and souvenirs at the Festival. And, we will also be stopping during our car rides for meals. So feel free to send your son/daughter with extra funds for that. When is everything due? Everything is due on or before June 26th. What do I need to hand in? We need $150.00 in cash or check (Made out to Second Cape May Baptist Church.) And, pages 3, 4 and 5 in this packet. What should my student pack? When we get closer to our trip we’ll be sending out a reminder of what to pack, but here’s some things to keep in mind as you prepare. All students will need to bring their own pillow, sleeping bag, towel, toiletries, extra clothes, warm clothes, flashlight, Bible and a tent (or plans to share a tent with someone.) What is the purpose of the trip? All our students get exposed to a variety of different music and entertainment with artists who are focused on Jesus Christ. It’s an amazing thing to watch thousands gather together to worship our Creator.
What about cell phones? This trip is slightly different than others we take through the year, and you are more than welcome to bring your cell phone, and your iPod along. Who can I contact in case of an emergency? There will be plenty of available leaders whom you can contact if you need to get in touch with your son/daughter. Pastor Jeff: 609-425-7929 Heather Peterson: 609-705-6972 Kendra Kammerer: 609-602-7464 When are you leaving? We’re leaving on Wednesday Morning at 7:45am. Please arrive by 7:30am to have sufficient time to load the van and ensure all your paperwork is in order. When will you return? We’ll return back at church at 4:30pm on Sunday afternoon.
If there is anything else we can answer or help you with please feel free to contact me at any time. We’re looking forward to a great trip to Creation. Pastor Jeff 609-425-7929 email@example.com
Our Medical Packet you need to return.