Michael Jordan. Questions? Please contact: Director of Youth Ministry. Phone: x230

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1 What: Youth will travel to Idaho to partner with Idaho Servant Adventures, a ministry of Lutherhaven. During this servant-leadership camp, we will work alongside other youth groups repairing and transforming homes, lives, and communities including our own. Who: RLC Youth who completed Grades 9-12 by Summer 2017 and their friends! When: July 15-22, 2017 Cost: $550 (Scholarships Available) Registration deadline: February 5, 2017 Sign-Up: Sign up online at rlcweb.myshelby.org A nonrefundable deposit of $100 is required. Pay online or via check made payable to Roseville Lutheran Church with Idaho Student s Name in the memo line. Full payment will be due May 5, Questions? Please contact: Michael Jordan Director of Youth Ministry Roseville Lutheran Church 1215 West Roselawn Ave Roseville, MN Phone: x230

2 High School Mission Trip 2017: Idaho Servant Adventures July Idaho Servant Adventures is part of Lutherhaven Ministries. Our youth will be engaging the community through relationships and service. ISA creates environments for teens to grow in faith and love through service. This program includes dynamic speakers, professional staff, caring adults, meaningful programming, devotions and Bible studies, intentional leadership development; simple, significant service opportunities; and wild outdoor adventure. Learn more about ISA online Saturday, July 15 Meet at RLC at 6 am. Load the van and hit the road Please be on time Pack a lunch. (We will take rest stops along our drive, but not a restaurant stop). Arrive in Billings, MT to spend the night. (Church location TBD). Sunday, July 16 Depart Billings, MT for Idaho Servant Adventures 4 PM Arrive at ISA Go through orientation, overview of the week, service team assignments, and campfire Monday - Thursday (typical schedule) 6:30 Wake Up Mornings Breakfast, Devotions, Camp Chores 8:30 Depart for Service Sites. At sites until 3 PM Afternoon Free Recreation Time at camp Options include zip-line, rock wall, tubing the river, swimming, giant swing, and horseback riding Evening Dinner, Program, Trading Post, Campfire, Church Time 10:30 Lights Out Friday, July 21 Depart Idaho Servant Adventures by 6:30 AM Spend the morning & afternoon enjoying white water rafting along the Clark Fork River. Please bring extra money for lunch that day Stay overnight in Billings, MT (church location TBD). Saturday, July 22 Depart Billings, MT for RLC. Bring money for lunch! Arrive back at RLC sometime in the evening. NOTE: Youth are encouraged to bring extra money to purchase gear & snacks while we re at camp. Emergency Contact Information Trip Leader: Michael Jordan Mobile: (218) *Please: Only call in case of an emergency. Social Media: Get updates on our journey on on and on Instagram: youthofrlc Questions? Please contact Michael Jordan at

3 IDAHO SERVANT ADVENTURES Traveling Health Form & Releases To be completed by all participants! Travel to your Idaho Servant Adventure with two copies: one for you and one for us! Print Form, Fill-in & Sign Dates Attending: at Shoshone Mountain Retreat at Camp Lutherhaven Name of Church City/State Your Group's Primary Adult Leader YOUR Name Date of Birth Last First Male Female YOUR Address Street Address City State Zip If under 18: Parent Home Phone Parent Work Phone Parent Cell Phone Parent(s)/guardian(s) Name/s Parent/guardian address (if different from above) Street Address City State Zip EMERGENCY CONTACT 1 Name Relationship to me Home phone ( ) Work phone ( ) Cell Phone ( ) EMERGENCY CONTACT 2 Name Relationship to me Home phone ( ) Work phone ( ) Cell Phone ( ) Revised 5/25/2016 by BB, page 1 of 4

4 Medical Information Please Include A Photo Copy of the Front & Back of Insurance Card! The following information is provided for any licensed physician, dentist, or hospital not having access to my medical history Life threatening or severe health threatening allergies to food, medications, bee stings or other, list: Other allergies, list and include symptoms/reactions: Medical condition(s) we should know about: Date of last DTaP or Tdap immunization WE STONGLY RECOMMEND YOUR TETANUS VACCINE IS UP TO DATE! Primary Health Care Provider Phone ( ) Dentist Phone ( ) Medication(s) brought with you, list and include reason for taking Medical Insurance Company Address Insurance ID number Group Number Description of any limitations or restrictions on activities Permissions & Liability Release Medical Release I consent to first aid and emergency medical care for me or my child/ward and authorize, if necessary, admission to a hospital for treatment of injuries that I or my child/ward could sustain while participating in this program. I understand that I am responsible for any and all medical expenses that may be incurred by myself or my child/ward, including emergency medical transport, as a result of any accident or illness while participating in the program. I give permission for Idaho Servant Adventures to provide transportation or arrange for transportation through Emergency Medical Services, if needed, for me or my child/ward for medical care. Parent/Guardian Signature Date / / OR Participant Signature Date / / if 18 or older Note: All participants 18 and older complete and return the Voluntary Disclosure Statement Revised 5/25/2016 by BB, page 2 of 4

5 Lutherhaven Ministries Coeur d Alene, Idaho Equine Liability Release required for all participants interested in a horseback trail ride. The form must be brought to camp completed and signed by the legal parent or guardian and participant. Trail passes cost $20. For more information visit EQUINE LIABILITY RELEASE AND INDEMNITY AGREEMENT TO BE READ AND SIGNED BY PARENT/LEGAL GUARDIAN (OR PARTICIPATING INDIVIDUAL, IF 18 YEARS OLD OR OLDER) BEFORE PARTICIPATING IN EQUINE ACTIVITIES FROM SHOSHONE BASE CAMP. This document is two pages. I, (print full name), have requested on my or my child s/ward s behalf to participate or allow my child/ward, (print child s full name), to participate in an equine activity from Shoshone Base Camp as part of an event sponsored by Lutherhaven Ministries. As a condition of participating in this activity, I, the undersigned, do hereby agree on my or my child s/ward s behalf to the following: I understand that my or my child s/ward s participation in any activity involving horses can expose me or my child/ward to dangers both from known risk and unanticipated risk which may result in my or my child s/ward s bodily harm, severe injury, property damage, or death. Acknowledging that such risks exist and that I am not relying on Lutherhaven Ministries to list all possible risks to the participant, I hereby release and discharge Lutherhaven Ministries and its officers, agents, and employees from any and all claims or liability for personal injury, property damage or death I or my child/ward may incur as a result of participation in this activity, including, but not limited to, any claim arising out of any condition of the area in which the activity is held, condition of the horses used, or the conduct of any person in connection with the preparation of, supervision of, or conduct of the activity, whether planned or unplanned, in connection with the activity. I specifically agree on my or my child s/ward s behalf to release and do hereby release Lutherhaven Ministries and the officers, agents, and employees of Lutherhaven Ministries for any negligence of Lutherhaven Ministries or the officers, agents or employees of Lutherhaven Ministries. I further agree to indemnify and hold Lutherhaven Ministries harmless from any and all injuries or damages incurred by my child/ward in connection with equine activities. I or my child/ward agree to comply with all rules and regulations of Lutherhaven Ministries. If I or my child/ward have any questions or concerns or observe any unusual or unnecessary hazard during my participation, I or my child/ward will immediately notify the nearest instructor, staff person or director of Lutherhaven Ministries. Revised 5/25/2016 by BB, page 3 of 4

6 I understand that under Idaho Code an equine activity sponsor or professional may have immunity from liability for any injury to or the death of a participant or equine engaged in an equine activity. I understand that under certain circumstances an equine activity sponsor or professional may not be immune from liability; however, I, on behalf of myself or my child/ward, hereby waive any and all rights I or my child/ward have or may have to make any claim against Lutherhaven Ministries and/or any officers, agents and employees of Lutherhaven Ministries under Idaho Code I acknowledge that I have the opportunity to consult with an attorney regarding this Release, and I sign it of my own free will. READ CAREFULLY! SIGNING THIS FORM AFFECTS YOUR OR YOUR CHILD S/WARD S LEGAL RIGHTS AND THE RIGHTS OF YOUR SUCCESSORS! Participants Signature Date AND Parent/Legal Guardian Signature Date if Participant is Under 18 Revised 5/25/2016 by BB, page 4 of 4

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