imagine road tripping together around North-
west Iowa in a charter bus all night long! This all-night, travelling “lock-out” is for Sunnybrook high school students, and we have limited seats available. Stuff we’ll do We’ll travel all over Northwest Iowa in charter busses. We’ll drive to different stops all night long and have small adventures, eat food, goof around, hang out with each other, and get to know Jesus better. Some stops will be goofy, some stops will be tasty, some stops will be eye-opening. Activities include (weather permitting): indoor swimming, ice skating, bowling, go-carts, batting cages, coffee shops, college campuses, praise and worship, corn maze, barn dancing, cardboard wars, and enjoying the great outdoors. Date and Times Meet at 8:00 p.m. on Saturday, Sept. 18 at Sunnybrook. We’ll then depart in charter busses to our first destination somewhere in Northwest Iowa. We’ll get back to church on Sunday morning at 6:30 a.m., and students can head home. registration & DEADLINE Registration forms and payment are due Wednesday, Sept. 8. Staple $75 (check or cash) to the registration form and turn it in before Sept. 8 With limited seats available, forms are taken on first-come, first-serve basis. Registration forms have to be filled out with payment attached or they won’t count. Stuff you agree to if you go on this road trip • You’ll follow the rules. You’ll be respectful to everyone (students and adults) on the trip. • You won’t be allowed to fall asleep.
• If you go on this trip, you can’t leave on your own at anytime. You’ll have to stay with the group the entire time. • Your interactions with the opposite gender will be appropriate, respectful, and pure. • You understand that if your behavior or attitude is a burden to the leadership on this trip, we’ll send you home. Frequently Asked Questions Can I bring a friend that doesn’t go to our youth group? Yep, but only one friend of the same gender. What should I bring? Bring a swimsuit (one piece or “tankini” for girls), towel, warm clothes, sweatshirt, socks and shoes appropriate for outdoors and ice skating, warm coat, winter hat, gloves, and a flashlight, a travel bag/backpack, and $10 spending cash. Is there anything I shouldn’t bring? Don’t bring iPods or other gadgets that might get broken or stolen, mean friends, snacks, drugs or alcohol, a bad attitude, the desire spend the whole time with a boyfriend or girlfriend, or unwillingness to be challenged by God. What if I register and then I can’t go? Can I get a refund? Once you’ve registered and paid, we can’t provide refunds. Registration payments are being used to purchase materials and food for the Road Trip. What if my registration is over the seating limit? You’ll be put on a waiting list. If a spot does not open and you do not go on the Road Trip, your money will be refunded. Parent chaperones needed Contact Chuck Jespersen at 276-7915 ext. 28 or charliej@ sunnybrookchurch.org if you are interested.
Staple $75 (cash or check) to the corner of this form and turn it in to Sunnybrook by Wednesday, Sept. 8. If you’re using cookie dough/fund raiser money that you’ve earned, write the amount here: ___________________
If you’re not sure how much money you have in your account, call or e-mail Chuck Jespersen before you turn in this form. If you don’t have enough cookie dough/fund raising money, your registration won’t count so confirm it with Chuck ahead of time.
Student/Participant Name: _________________________________________________________________________________ School: ____________________________________ Birth Date: ____/____/______ Age: ______ Grade: 9 10 11 12 Do you attend Sunnybrook’s youth group? Y N
If not, who are you coming with? __________________________
Parent/guardian name: ____________________________________________________________________________________ Parent e-mail: ___________________________ @ ___________________________ Parent Cell: _______________________ Address: ____________________________________________________________ Home Phone: ________________________ Emergency Contact: ______________________________________________________ Phone: ________________________ Insurance Company: ________________________________________ Group #: ____________________________________ Choice of coffeehouse drink:
Hot apple cider
French vanilla cappuccino
Are you (student/participant) pregnant at this time? Y N List any allergies, meds to control them and their effects (insect bites, med allergies, food allergies, etc.) List any medical/health conditions (diabetes, epilepsy, etc.) and meds to treat their effects List all recent injuries, broken bones, illnesses or operations, beginning with most recent (list month and year) List any emotional/behavioral considerations and their effects on you (fear of heights, insects, etc.) To be read & signed by PARENT/GUARDIAN
As parent/legal guardian, I hereby give permission for my child to participate in “High School Road Trip” Sept. 18-19, 2010. I understand that the Sunnybrook organizers do not carry medical and hospitalization coverage for my child. I understand that my personal medical and hospitalization insurance policies will provide primary coverage. I further understand that in the event my child requires medical or dental treatment while engaged in the activity, reasonable efforts will be made to contact me. However, if I cannot be reached I hereby give consent and permission to my youth director or any adult organizer or volunteer acting on behalf of ”HS Road Trip” with respect to the activity, as agent for me, to administer or dispense: over the counter medications for the relief of minor aches, abrasions, cuts, or irritations, and consent to any x-ray, examination, injections, anesthesia, medical, dental, or surgical diagnosis and treatment and hospital care and treatment advised and supervised by a licensed physician, surgeon, or dentist (as appropriate) licensed to lawfully practice in the State where the services are rendered; either as an outpatient or by any hospital. To the best of my knowledge I have listed, above, all of my child’s known allergies, medications and prescriptions to be taken, medical conditions and other pertinent information. I agree to pay any and all expenses for my child being sent home, or I’ll come get him/her myself, if such disciplinary action is deemed necessary by the “HS Road Trip” organizers or volunteers. I agree that if my child shares any information about physical or emotional behavior or any condition that, in the opinion of Sunnybrook leadership, may be harmful to them, I, as a parent or legal guardian, may be informed.
Parent/Guardian Signature: ______________________________________________________ Date: ___________________ To be read & signed by STUDENT
I agree to follow the behavior rules and obey and respect the adult chaperones for “Road Trip”. I also agree that if I share any information about me participating in behavior that is hurting myself or others, or if others are hurting me physically or emotionally, my parents/guardians may be informed (as long as that doesn't put me in any further danger at home).
Student/Participant Signature: ____________________________________________________ Date: ___________________