All Girls Retreat Jan 21-23, 2011Registration begins Friday at 7:00 PM.

Name Address City ST ZIP Phone# ( ) - E- Mail Church Church city Housing request Special Dietary Needs

Retreat Cost $90.00 Early Registration Discount -$10.00 Less Deposit $25.00 Payment Due ______

Please make check payable to VCBC, OR:

Charge $ to my credit card

[ ] Visa [ ] MC [ ] Discover [ ] Am. Exp.

Exp. Date /

Acct. # - - -

Signature

Optional activities:

Cross Country Skiing Skating

Paintball Game $10 Sledding

Trail Ride $12 Gym/Game Room

Please remember to fi ll out the back side!ww

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Form must be sent on or before Jan. 11 to receive early discount.

Janu

ary 21

-23 , 2

011

All

Girl

s Retr

eatRegistration

Form

Spea

ker:

Am

y C

arlso

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my

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Amy

has

been

mar

ried

for

16

m

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r 1

6

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nd

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he a

nd h

er h

usba

nd

have

four

kid

s. S

he h

as

have

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Village Creek Bible CampMedical Release Form

Name_________________________________Birth date ____________ M/ F Age________Parents/Guardian ________________________Daytime Phone # ________________________Address________________________________City_____________ State_____ Zip_________

Emergency Contact ______________________Emergency Phone # ______________________2nd Emerg. Contact _______________________2nd Emerg. Phone # ______________________

Physician’s Name ________________________Physician’s Phone # ______________________Health Insurance Co. & Address ____________ ______________________________________Policy # _______________________________Health Problems / Special Needs ___________ ______________________________________Drug Allergies __________________________Regular Medication ______________________Activity Restrictions _____________________

Parents!Please read, sign and date the following:Our insurance coverage is a primary carrier. Our policy will provide you with complete coverage within its limits, subject to policy provisions. IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for and to order injection anesthesia or surgery for my child, as named above.Signature Date

Friday evening:

7:00 Registration

8:00 Snack w

hen arrive9:00

1st Session 10:30

Evening game

Saturday:

8:00 W

alk-thru Breakfast9:00

Session10:30

Seminars

11:00 M

orning Activities

12:30 Lunch

1:30 A

fternoon Activities

3:00 C

anteen/camp store

5:30 Supper

7:00 Session

8:30 C

ampfire

Sunday:

8:30 Breakfast

9:00 C

losing Session11:00

Brunch

What to bring

Bible, notebook, pen, personal

grooming articles, bedding, towel

and washcloths, hard soled shoes for trail riding, tennis shoes for the gym

, and long sleeves for paintball.

vcbc@villagecreek.net 1

58

8 D

rake Rd L

ansing IA 5

2151

TentativeS

cheduleA

Few

Sem

inar Options:

Nutrition

Dating &

Relationships

Special A

ctivities:Z

umba

DoxaSom

a

Foot spas

Informal m

anicures

Crafts

Chocolate B

uffet

And all of the outdoor fun that

January provides!