go
Registration Otse reen
ow ling G and m
or
B w ood aroun e from
Name________________________________________Sex M F E lm d Ohi
stw ood o!!!
Address________________________________________________ E a
Phone______________________School______________________
Parent(s) Names_________________________________________
I give my permission for my son / daughter to attend the Young Life
Annual
ll W e e k e
Fall Weekend
Signature of Parent/Guardian
x______________________________________________________
F a n d
Please fill out the above portion and the back of this form and
return it with your $35 Deposit to your YL Leader. Please make
checks payable to “Young Life” and in the memo portion write “Fall
2008
Weekend Fees”. The cost of the weekend is not tax deductable.
November 21-23
Of Interest to Parents
Young Life is having one of its weekends for high school students. Since your son or
daughter is interested in attending, you may be wondering what Young Life is.
It’s Coming...
Young Life seeks to make exciting recreational opportunities available to teens while you and 300 of your closest friends... hanging out, huge
at the same time allowing them a chance to consider the basic questions of Christian-
ity. Our objective is to present the Christian faith in simple, understandable terms Clubs, field games, classic YL entertainment,
through meaningful relationships. By doing this, we hope to show them in words and P.W. Gopal in concert!!!
actions a way to build constructive lives as they grow into adulthood.
one incredible weekend!!!
Responsible adult leaders will run a well-planned program for the entire weekend. If
you have any further questions please contact our office at:
Young Life Wood County
P.O. Box 284
NOTE: OSU v. MICHIGAN
Bowling Green, OH 43402
Jens Hatch (419) 308-5944 or Email
[email protected] Game will be shown on large screen!!!
Young Life Parental Consent for Medical Treatment
• Return - 1:30PM @Bowling Green High School
WHAT ELSE SHOULD I KNOW?
Elmwood - Kerry Flahie (419) 367-0662, Kelsey Adams (513) 417-2914, Daniel Stoots (419) 494-1709, Brad Reinhard (419) 262-5387
• Depart -6:00PM @Bowling Green High School
Young Life always carries accident insurance for participants in any Young Life activity. Your son or
• Extra pair of clothes and shoes that can
• $35 Deposit & Parental Consent form
daughter is planning to participate in one of these activities. With the increasing sophistication of our
Otsego- Craig Flack (567) 277-0828, Brianna Votaw (614) 975-1459, Darin Eding (419) 944-0803, Jamie Hoke (419) 575-0992
medical systems, we are finding it expedient to have parental release forms in the unlikely event of some
• Checks should be made payable to
serious injury requiring medical treatment. This release gives us permission to take your child to the
• Sleeping bag and pillow - a must!
WHAT DO I BRING?
nearest available medical facility and have the necessary treatment administered. Many hospitals will
(No ipods or cell phones)
not administer any medical attention to a minor without some parental consent. Therefore, please read
Eastwood- Julio Mata (956) 536-2669, Becky Comston (614) 425-2578 , Joy Ashton (614) 560-3216
the statement in capital letters and add your signature to it. All this does is give us the permission to seek
whatever medical attention we deem necessary. Our insurance is explained below.
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
Bowling Green- Ashley Rozelle (614) 551-0052, Joel Metzger (419) 575-1851
• Sweatshirt/rain gear
TO ACT ON MY BEHALF IN SEEKING EMERGENCY TREATMENT FOR MY CHILD IN
• Your final payment
THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY BY YOUNG LIFE. I GIVE
PERMISSION TO THOSE ADMINISTERING EMERGENCY TREATMENT TO DO SO, USING
be thrown away
holds your spot
• Towel/toiletries
THOSE MEASURES DEEMED NECESSARY. I ABSOLVE YOUNG LIFE FROM LIABILITY IN
“Young Life”
ACTING ON MY BEHALF IN THIS REGARD SO LONG AS YOUNG LIFE IS NOT GROSSLY
NEGLIGENT.
• Swimsuit
Name of Child______________________________________________________
(Please Print)
Signature of Parent or Guardian_________________________________________
Phone:_____________________________
Questions?
If parents are not available, please contact the relative below.
Name________________________________
ON A FIRST COME FIRST SERVE BASIS.
Counties as well as County Line, Newark &
WEEKEND, ALL SPOTS WILL BE SOLD
DUE TO THE POPULARITY OF THIS
Phone_________________________
HOW MUCH DOES IT COST?
People from Wayne, Wood & Stark
• Food and Lodging (2 Nights & 4 Meals)
Address__________________________City__________________Zip_________
WHO WILL BE THERE?
Heartland Retreat Center
Additional comments regarding medical history, allergies, penicillin or drug reactions,
etc., which may be needed in any treatment.
WHERE IS IT?
3201 County Road 225
heartlandretreat.com
________________________________________________________________________
Marengo, OH 43334
Cambridge, OH
IMPORTANT!!
________________________________________________________________________
$95 includes:
________________________________________________________________________
There is no deductible with the Young Life coverage. The first $250 in medical expense is covered by the
• Transportation by bus
Young Life insurance entirely. Any amount incurred above that will be coordinated with your personal
insurance. At that point the Young Life insurance will become the secondary carrier and will supplement
your coverage. The maximum amount available from Young Life is $4,000.
Parent or Guardian’s insurance company________________________________________
• All Activities
Parent or Guardian’s insurance company’s address _______________________________
_______________________________________________________________________
Parent or Guardian’s policy number____________________________________________
o I Hereby give permission for Young Life to use any pictures taken at Fall Weekend for
use in YL printed or multimedia material (YL website, Printed newsletters, etc.).
