ALL FORMS AND THE COST FOR THE RETREAT (MONEY) ARE DUE ON OR BEFORE TUESDAY NIGHT FEBRUARY 5, 2018 AT THE NORMAL FACEDOWN YOUTH BIBLE STUDY.

2018 Winter Youth Retreat to Mammoth Lakes California We will be going up to Mammoth for a four day three night stay February 16 th -19 th, 2018. This is over Presidents Day weekend and goes Friday through Monday. The following is an information packet containing all the details about the Retreat and all applicable forms and waivers which need to be returned along with total payment by Tuesday February 5, 2018. Deposits: We are breaking up the cost over 4 deposits leading up to the retreat in an effort to afford the deposits required by the camp. The deposit schedule is as follows: 1 st Deposit: $80 Due: January 2, 2018 2 nd Deposit: $80 Due: January 23, 2018 3 rd Deposit: $80 Due: February 6, 2017 4 th Deposit: $85 Due: February 13, 2017 The cost for this retreat is $325.00 per person. Hopefully this deposit schedule will also help in easing the total cost. There will be scholarships available, for scholarships please speak to Jeff Paisano, Youth Pastor. (Contact info listed below) Snowboarding/Skiing/Sleds: One of the options for an activity on this retreat will be snowboarding at Mammoth Mountain Ski and Snowboard Resort or June Lake Resort. For this activity there will be a separate information page. Please read thoroughly to make sure you know all the details and costs involved. For those not going to Mammoth, there is an option to go to Sledz, an amazing sled resort this will cost $25 per person additional to retreat costs and can be paid along with retreat money. ALL FORMS AND THE COST FOR THE RETREAT (MONEY) ARE DUE ON OR BEFORE TUESDAY NIGHT FEBRUARY 5, 2018 AT THE NORMAL FACEDOWN YOUTH BIBLE STUDY. Departure and Return Information: We will meet at Reverence (22081 Hidalgo, MV) Friday morning Feb. 16 at 5:00am and leave by 6:30. We will then be returning to the same location on Monday Feb. 19 th around 7:30pm. We will have all retreat goers notify parents in the event that we run late or by God s grace we are early. For more information or questions please call or e-mail: Jeff Paisano Cell: 949-929-4493 jeff.paisano@reverencechurch.org www.facedownyouth.org

Retreat Agenda Friday 5:00am 6:30am 2:00pm 6:00pm 8:00pm 10:00pm 11:00pm Meet at RBC New Church Property with all luggage. Leave for Mammoth Lakes CA Arrive and unpack Dinner Intro to Winter Retreat Bible Study 1 Worship- Worship team. Games / Bonfire Lights Out Saturday 7:00am Personal Devotion Time 8:00am Breakfast 9:00am Morning Worship and Breakout Session #1 11:00am Activity: Serious snow play session 12:00pm Lunch while out and about (Sack Lunches) 4-6pm Rest Session (nap, relax just make sure you re awake for bible study) 6:00pm Dinner 8:30pm Bible Study 2 Worship- Facedown Worship team. 9:30pm Games/Bonfire 11:00pm Lights out Sunday 7:00am 8:00am 9:00am 10:00am 12:00pm 4:00pm 6:00pm 8:30pm 10:00pm 11:00pm Monday 8:00am 9:00am 10:00am 12:00pm 7:00pm-ish Snowboarding Group leaves for Mountain (breakfast on hill) Breakfast (for group staying) Morning Devotion Worship Facedown Worship Team Activity: Sledz Tube Park and Gondola to Canyon Lodge Lunch @ Canyon Lodge pack a sack or bring $ to purchase lunch there. Nap and relax session till dinner. Dinner Bible Study 3 Worship Facedown Worship Team Games / Bonfire Lights Out Breakfast Closing Bible Study 4 Worship Facedown Worship Team Clean Cabins Leave to return home lunch on road. Arrive home

Winter Retreat RBC Facedown Youth As an option for one of the activities on our Facedown Youth Winter Retreat, we will be going snowboarding/skiing at Mammoth Mountain Ski and Snowboard Resort. Again this activity is not required; there will be optional activities for those not going snowboarding/skiing that day. Our plan is to go on Sunday for a full day session starting at 8:00am and ending at 4:00pm. Following are all the details for the snowboarding/skiing activity. Details: We will go for Full Day on Sunday starting at 8:00am going till 4:00pm. We will stay as a group on the hill. All costs for snowboarding/skiing are the sole responsibility of each individual participating including Lift Tickets and any Rental Equipment needed. Reverence Bible Church (RBC) Facedown Youth Ministry will not be financially responsible for any costs involved in this activity. If parents would like to have the RBC Facedown Youth Ministry (RBCFYM) Leadership hold the money for their child (ren) that will need to be set up between the parents and the Leadership team and is an option. Each individual participant going skiing or snowboarding will be responsible for all equipment needed whether they are bringing their own equipment, borrowing or planning to rent. There will be an option to rent equipment at the resort, and this is recommended for all first time skiers and snowboarders. The Resort always has top quality equipment and they streamline the process for quick expedition. A leader will be taking a group of people needing to rent to the respective rental location at the Resort and overseeing the process. Again (RBCFYM) will not be responsible for any costs of rental equipment. You may bring your own equipment. (RBCFYM) will not be responsible for any lost or stolen personal items. Kids/Students/Individuals may not participate in snowboarding or skiing while on this Retreat without a Special Activities Waiver/Release of Liability and Permit to Treat signed by a legal parent or guardian. All that said, here are the current costs as we know them from their online advertising. It is possible that there may be discounts available to our group size as well as additional costs that they may not have disclosed. The prices are approximates. Prices: (per 2016) Full Day Lift Ticket: Youth 13-18 yrs old $80.00 Adult $107 Full Day Snowboard/ski Rental Package: Youth: $40 Adult $40 TOTAL APPROXIMATED COST S WITH RENTAL : YOUTH: 13-18 YRS OLD: $120.00 ADULT: $147.00 What you ll Need Following is a list of clothes items that are recommended for this activity. Warm Clothes Pants, snow/powder pants Jacket, Long Johns (ask your parents), Gloves, Goggles/eye protection, Following is a list of Equipment that is recommended whether renting or bringing your own: Board/skis, Leash (if snowboarding). Boots, Poles (if skiing) Bindings, Helmet (STRONGLY RECOMMENDED but not required), Change of dry clothes, Hat, Beanie. First timers should take some time to speak with one of the leaders that snowboards or skis to make sure they have all their bases covered or if they don t know what one of the listed items is, they can also help you to save some mula cause this sport aint cheap! Again these are only suggestions as to what will be needed.

What to Bring: Bible Note book and pens Highlighter Camera batteries and stuff Backpack (optional but nice to take a jacket in) Book-light CD Players and CD s are ok but NO I-PODS! Games (appropriate) Sleeping bag Pillow (s)? $ - Suggested Spending $ : about $30.00 (lunch on the ride up and any snack you purchase along the way will be out of your pocket.) Also there is a snack shack at camp. $25.00 for Sledz if you are going. Clothes: Warm Everything! Essentials: Shirts, Pants, Socks, Unders, Shoes Jacket (snow jackets are best but not necessary) Sweatshirt (keep in mind you will be given a sweatshirt at the beginning of the retreat) Snow Pants (if you have them, not a must if you don t) Sweat Pants (warm for sleeping in) Boots (?) Gloves Beanie Toiletries & Towel (Leave the long make-up process at home) Earmuffs?? Snow Boarding Gear: (see snowboarding page in retreat packet for a complete list) LUGGAGE: 1 Sleeping bag in garbage bag labeled (your name) 1 Bag for clothes and toiletries remember we are only there for 4 days! 1 Carryon backpack size for things you want while traveling.

Reverence Bible Church General Release of Liability 2018-2019 As a Christian group, we seek to follow the biblical mandate, which disallows bringing charges against Christian brothers in civil courts. We also seek to be good stewards of the resources and blessings that the Lord has provided. Our group has never had an instance of injury of damages being charged to the group. Yet we believe it is best to be sure all members understand our position prior to any mishaps. We are an organized non-profit church group. The leadership is made up of those who have volunteered their time to organize activities for the group. Participation in any event is strictly voluntary, with no member ever being required to attend any meeting or event. Neither our group, nor its leaders, nor its members are liable for any injuries or damages, whether connected with Reverence Bible Church event or not. At every event, parents are responsible for their own children. Children are never allowed to attend any function without a parent. Occasionally a member will desire to send his child (ren) to an activity with another adult member. This practice is discouraged, yet because we understand that occasionally the parent must remain home because of illness in the family, pregnancy, etc., and because of the family-like nature of our group, we do not desire to prohibit it under all circumstances, In any case, no child is allowed to attend any event without being accompanied by and supervised by his own parent or, in special cases, accompanied by and supervised by an adult member designated by that child s parent to take complete responsibility for him. We suggest that if you find it necessary to send your child to an event with another adult, it be one who is comfortable enough with your child to correct him if necessary. Any special guests (grandparents, relatives, out-of-town friends, etc.) who accompany members to any event are under the sole responsibility of that member for behavior, damages, injuries, etc. It is expected that any member or his child or guest who damages property or who causes injury, either willfully or through neglect, will take personal responsibility for his actions. However, our group will not be involved in any way in such situations. Any person, whether member or not, who has such a claim will be directed to discuss the offense individually with the part he believes to be responsible. The outcome of such a problem is out of the realm of this group s responsibility. If such disputes cannot be handled by the parties individually, we will expect that they will follow the guidelines of Matthew 18: 15-35 thorough their own churches and church leadership. In the remote event of a catastrophe injuring members while at a group event, we require a MEDICAL RELEASE FORM for each child to be signed and on file. (one copy with the secretary and one in the field trip/event packet which we will attempt to have on hand at every event.) No child may participate in any activity without such a form being filled out and signed by the child s parent/guardian first. I have read the above and agree to hold Reverence Bible Church harmless in the event of any damages or injuries to me, to my children, or to my property. Childs Name (Printed) Age Parent/Guardian Signature Self Signature (18 and over) Age ( ) Parent/Guard Emergency Cell Phone Number ( ) Parent/Guard Emergency Home Phone Number

Reverence Bible Church, Facedown Youth Ministries Special Activity Release of Liability For Winter Retreat 2018 Mammoth Lakes, CA As a Christian group, we seek to follow the biblical mandate, which disallows bringing charges against Christian brothers in civil courts. We also seek to be good stewards of the resources and blessings that the Lord has provided. Our group has never had an instance of injury of damages being charged to the group. Yet we believe it is best to be sure all members understand our position prior to any mishaps. We are an organized non-profit church group. The leadership is made up of those who have volunteered their time to organize activities for the group. Participants Name: s participation in any event, including but not limited to: skiing, snowboarding, sledding, snow sliding, ice skating, snow play, snow throwing, hiking, games, horseback riding, sledding, dog sledding, or bob sledding, is strictly voluntary, with no member ever being required to attend any meeting or event. Neither our group, nor its leaders, nor its members are liable for any injuries or damages, whether connected with Reverence Bible Church Facedown Youth Ministries Retreat events or not. However, care will be sought out for any injuries that may be sustained in the event of an accident. I have read the above and agree to hold Reverence Bible Church and leaders harmless in the event of any damages or injuries to me, to my children, or to my property. Parent/Guardian Signature Parent/Guardian Signature Self Signature (18 and over)

Reverence Bible Church Medical Release 2018-2019 Name of Child Birth : of last Tetanus booster Health problems, medical or food allergies: Name of Child Birth : of last Tetanus booster Health problems, medical or food allergies: Name of Child Birth : of last Tetanus booster Health problems, medical or food allergies: Name of Child Birth : of last Tetanus booster Health problems, medical or food allergies: Name of Child Birth : of last Tetanus booster Health problems, medical or food allergies: I (We) the undersigned parent, parents, or guardians of the minor child(ren) named above, do hereby authorize and consent to any X-ray examination, anesthetic, medical or surgical diagnosis and treatment and emergency hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act and on the staff of any acute general hospital bolding a current license to operate a hospital from the State of California Department of Health Services. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority to render care, which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that every effort shall be made to contact the undersigned prior to rendering treatment to the patient(s), but that any of the above treatment will not be withheld if the undersigned cannot be reached. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. The undersigned also assumes the responsibility for any of the costs connected with such treatment and hereby releases the leaders and members of Reverence Bible Church from any liability therefore. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under any emergency circumstances in my absence. Parent/Guardian Signature Parent/Guardian Signature Home phone number Emergency Phone/Pager Address City State Zip Physician s Name Phone Number Insurance company and policy #

Medical Information DATE OF CAMP CAMPER/GUEST INFO: NAME AGE DATE OF BIRTH Print Last Name First Name ADDRESS CITY STATE ZIP HOME PHONE ( ) CELL PHONE( ) E-mail O Male PARENT/GUARDIAN INFO: NAME(S) O Female ADDRESS CITY STATE ZIP HOME PHONE ( ) FAX NUMBER ( ) MOTHERS WORK PHONE ( ) FATHERS WORK PHONE ( ) MOTHERS CELL PHONE ( ) FATHERS CELL PHONE ( ) If parent/guardian cannot be reached in case of emergency, please contact: NAME RELATIONSHIP TO CHILD PHONE ( ) INSURANCE INFO: NAME OF INSURANCE COMPANY PHONE ( ) ADDRESS POLICY # GROUP # EFFECTIVE DATE POLICY SUBSCRIBER SUBSCRIBER S BIRTHDATE SUBSCRIBER S ADDRESS SUBSCRIBER S PHONE ( ) FAMILY DOCTOR PHONE ( ) ADDRESS HEALTH HISTORY: Please check if camper/guest has experienced any of the following: Hemophilia/Bleeding Disorder Anxiety Hypertension Hepatitis/Liver Disease Kidney Disease Mitral Valve Prolapse Asthma/Other Respiratory Disease Physical Handicap HIV/AIDS Heart Condition Sleep Walking Ear Infections Epilepsy/Seizure Disorder Ulcer/Stomach Disease Bowel Disorder Rheumatoid/Lupus Rheumatic Fever Behavior/Nervous/Mental Disorder Diabetes Bed Wetting Other If any of the above are checked, please give details (i.e. include normal treatment/symptoms of allergic reactions, etc.) List all previous surgeries: List all allergies: Does camper have any allergic reactions to the following: Bee Stings Hay Fever Poison Ivy Poison Oak Poison Sumac Peanuts Other Non-Prescription and Prescription Drugs: Parents and/or legal guardians are required to disclose any medication your child is taking. The Station requires all campers and visitors disclose any medication they are taking. Written physician s directions should accompany any prescription medicines sent to camp, and should be in the original container, labeled by pharmacist. These directions must include: medication, dosage, frequency, condition being treated, physician s signature and DEA number. (If your child requires an Epipen for allergic reactions, he/she must have it on their person at all times.) (THE STATION staff will distribute meds, but camper must administer it themselves.) Name, dosage, and frequency of any medications that must be taken regularly or as needed: 1

of last tetanus shot: Any swimming restrictions: Yes No Any activity restrictions: Yes No If yes, what restrictions? MEDICAL RELEASE: I,, hereby give my permission to the medical professional selected by The Station to hospitalize, to secure proper treatment and/or order an injection, anesthesia, or surgery for myself as deemed necessary. I also understand that The Station staff is certified in basic First Aid and CPR, and authorize staff to administer these skills if necessary for illness or injury. This form may be copied and given to The Station staff/volunteers and/or medical personnel if there is information pertinent to care. I understand that I am financially responsible for any amount not covered by my insurance contract. I also authorize you to release to my insurance company information concerning health care, advise, treatment or supplies provided to myself while attending The Station. This information will be used for the purpose of evaluating and administering the claim of benefits. A photocopy of this authorization shall be considered as effective and valid as the original. Guest Signature (You may sign your own release if you are 18 or older) Print Name Spouse s Name 2

Registration Form DATE OF CAMP CAMPER NAME BIRTH DATE AGE MALE/FEMALE (circle one) GRADE CHURCH/ORGANIZATION ADDRESS CITY STATE ZIP EMAIL ADDRESS Parent/Guardian Info: PARENT/GUARDIAN NAME(S) ADDRESS (if different than above) HOME PHONE( ) CELL PHONE( ) WORK PHONE( ) EMAIL ADDRESS I authorize the staff at The Station to act for me according to their optimum judgment in any emergency necessitating medical attention, and I waive any and all claims for personal injury, illnesses and/or property damage that I may have against The Station, and its employees, directors, contractors, and every volunteer in any way associated with The Station. I understand that involvement in snowboarding, skiing, snowshoeing, cross country skiing, walking, hiking, rock climbing, backpacking, mountain biking, swimming, wake boarding, horseback riding, and all other camp activities involve the risk of injury and/or death, and I authorize my child to participate in such activities. I agree that The Station is not liable for personal items that are stolen, lost, or damaged. All medical expenses acquired will be the responsibility of the camper or the camper s family. I have no knowledge of any physical or mental impairment that would be affected by my child s participation in the camp program. I also grant to The Station, and any third party authorized by The Station, the right to film, videotape, photograph, and record the voice of my child for promotional purposes. Parent or Guardian Signature I agree not to take unreasonable risks while participating in snowboarding, skiing, snowshoeing, cross country skiing, walking, hiking, rock climbing, kayaking/canoeing, backpacking, mountain biking, swimming, wake boarding, horseback riding, and all other camp activities, including causing anyone else unreasonable risk of harm. I also agree to follow correct safety procedures, to respect The Station staff/volunteers, my peers, and the rules established at The Station. I also grant permission for The Station, and any third party authorized by The Station, the right to film, videotape, photograph, and record my voice for promotional purposes. Camper Signature