Both youth and advisors complete this form
and bring to the retreat if you have registered online,
(see other registration form if you plan to send
it by regular mail),
along with $60.00. (make checks payable
to "M.A.D. Youth.")
the price is the same for both youth and advisors
Covenant
Agreement
I have read the Winter Retreat guidelines and promise that I will abide by them during my stay at Camp Hashawha. I recognize that the Winter Retreat is a time for educational and spiritual growth as well as being an event that is fun and fellowship. I am qualified by my age AND school grade to attend. If I am an advisor, I understand that this is for Senior Highs ONLY and will not bring under-age youth or children to this event. I agree to attend the Winter Retreat in a positive spirit and be responsive to those in leadership positions.
Registrant Signature: Date:
Medical
Release
I, the undersigned, give permission for my child, , to attend and participate in activities sponsored by the Church of the Brethren Mid-Atlantic District Youth on Jan. 23-25, 2009. I authorize an adult in whose care my child has been entrusted, to consent to any necessary medical diagnosis, treatment, or hospital care.
Medical Insurance Co. Policy #
Parent/Guardian Signature (or participant, if over age 18)
Emergency Phone:
In return for the admission of (name of visitor)
into the Hashawha Environmental Appreciation
Center, I hereby release Carroll County and its officers, agents, employees, and
volunteers from all actions, causes of action, damages, claims, or demands which
I, for myself or on behalf of another, or my successors may have against them
for any personal injuries or illnesses which occur while the above stated
individual is attending the Hashawha Environmental Appreciation Center.
I have read this release and understand the Hashawha policies and
regulations and understand the terms. I executed it voluntarily and with fill knowledge of
its significance.
I have executed this release on the day and year written below.
Date of visit: Jan. 23-25,
2009
Signature of Visitor:
Date: