Fall Weekend Camp

Join the Mount Olivet Youth Staff for a long weekend of fall fun up at COP! This weekend is for members of Mount Olivet in 9th, 10th and 11th grades and 12th graders who were unable to attend the Senior Retreat.

Cost is $160.00 This includes, transportation, lodging and most meals.

We will be leaving from the Minneapolis Campus at 4pm on Thursday, October 19, 2017

and coming back at approximately 4:30pm on Sunday, October 22, 2017.

Event Details: Gina DeNucci at 612.767.2211 or ginad@mtolivet.org for any questions

Registration Details: Kris Ericksen, Krise@mtolivet.org or 612.767.2207

Student Information

First Name *

Last Name *

Primary Phone *

Participant Cell Phone

Gender *

Male

Female

Grade *

Participant Email address *

Parent Email address: *

Please email me updates

Healthform *

I attended COP summer 2017 and have a healthform on file

I need to update my COP summer 2017 healthform

I need to fill out a healthform

Emergency Contact Information

Parent Name *

Primary Phone Number *

Parent Name

Primary Phone Number

Emergency Contact Name *

Emergency Contact Primary Number *

Please use this box to tell us about any medical concerns that you feel is important for us to know about. Please also tell us if you child is on any medications that they will need to take while on retreat.

Permission Slip

PERMISSION/INFORMATION/RELEASE FORM MOUNT OLIVET LUTHERAN CHURCH 5025 Knox Avenue South, Minneapolis, MN 55419-1095 Phone (612) 926-7651 Fax (612) 926-4340 7150 Rolling Acres Road, P.O. Box 153, Victoria, MN 55386-7705 Phone (952) 767-1500, Fax (952) 470-4589

This form gives permission for my child to participate in and/or travel with Mount Olivet Lutheran Church, its staff, volunteers, representatives, agents, for all Mount Olivet Lutheran Church events for the program year of September 1, 2017 through August 31, 2018.

Please read the following statements carefully and date and sign this form:

By selecting you have read this form online, you are releasing Mount Olivet Lutheran Church, its employees, representatives, agents, and volunteers from any liability, personal injury, death, or property loss incurred in connection with the Event(s). You are also giving Mount Olivet Lutheran Church, its employees, representatives, agents, and volunteers permission to seek whatever medical attention is deemed necessary in the event of an emergency and to provide preventative care to minor children.

I/we understand that there are inherent risks involved with any trip or activity and, therefore, I/we agree (on behalf of myself, my spouse and/or my/our minor child) that Mount Olivet Lutheran Church, together with its employees, representatives, agents, and volunteers (collectively, “the Church”) shall not be responsible for and are hereby released from any liability for any personal injury, death, or property loss incurred in connection with the Event(s) of the time period noted above. I/we also authorize the Church to seek emergency medical treatment on behalf of me and/or my/our minor child in the event that such treatment is deemed necessary or appropriate by the Church and release the Church from any liability related to that decision or treatment. I/we further authorize the Church to provide preventative care to me and my/our minor child, including, but not limited to, the application of insect repellent and sunscreen and release the Church from any liability related to that care.

I/we understand that participation by me and/or my/our minor child in the Event(s) is voluntary. I/we further understand that any necessary transportation for the Event may be provided in vehicles driven by the Church or by third-party commercial carriers. I/we understand and agree that the scope of this release does not extend to willful, wanton, or intentional misconduct on the part of the Church.

Yes! I have read and agree to the terms and conditions of the above written permission/release form

Parent Initials *