Paintball* Polar Bear DipNight GamesLow Ropes Climbing TowerChapel

FootballHigh Ropes Challenge CourseHorseback Riding*Zipline

Bring All Your Adventure Seeking Buddies

* Additional permission signature and $10 fee required.

FallRetreat

OCTOBER 20-23 2011

Junior & Senior High

Berean Baptist Church309 E Co Rd 42, Burnsville, MN 55306Youth Offi ce 952.223.1847www.epicSM.com

Emergency Camp Phone Number 320.732.3218

ITEMS TO PACK Bring money for dinner on the way to camp

� Warm bedding (and pillow)

� Warm clothes and jacket

� Old clothes

� Long pants

� Two pairs of shoes (one old pair)

� Flashlight

� No electronics allowed

� Toiletries

� Bible

� Notebook

� Pen

� Swimsuit

� Towel

Fall Retreat 2011Permission Release

NAME ___________________________________________________

ADDRESS ________________________________________________

CITY _____________________ STATE ________ ZIP ______________

PHONE (__________) ____________-______________ GRADE ______

VISITOR? � YES � NO IF YES, BROUGHT BY ___________________

T-SHIRT SIZE � S � M � L � XL

I give permission for my child to join Epic Student Ministries of Berean Baptist Church on the EPIC FALL RETREAT `11 Weekend at Lake Beauty Bible Camp from Oct. 20- 23. I understand that the group will be traveling by buses and 15-passenger vans. I also understand the cost includes food, transportation, and all programming.

I agree that the staff member or adult in charge is authorized to solicit medical care in the best interest of my child in case of an emergency arising during the course of said minor’s attendance at the aforesaid function. I further understand and agree that my medical insurance coverage or other applicable insurance coverage, if any, are primary coverage for the protection of the child and that any insurance coverage provided by Berean Baptist Church are secondary coverage.

All participants must also have a “Berean Baptist Medical Consent” form on fi le at the church offi ce. They can be found on-line at www.epicsm.com. If you are unsure as to how to answer any of the questions, please contact us at 952.223.1847.

1. The church has a completed copy of the Berean Baptist Church Medical Consent form, signed by me (parent/legal guardian), on fi le for this current school year.

2. All health and insurance information (regarding question #1) is accurate and up-to-date.

3. All emergency phone numbers and medical information (regarding question #1) are up-to-date.

4. I give my consent to use pictures or video of my student on the Berean website or for event promotion.

Signature _________________________________________________ (PARENT OR LEGAL GUARDIAN)DATE ________/________/________

EMERGENCY PHONE NO. (__________) ____________-______________

PAID: � CASH � CHECK* (# ____________ AMT. _______________)

� CREDIT VOUCHER (AMT. ___________________)

*MAKE CHECKS PAYABLE TO BEREAN BAPTIST CHURCH———————————————————————————————Lake Beauty Bible Camp Horse Trail Ride Permission/Release Form

Camper Name (please print):_________________________________________

Horseback Trail Rides: I hereby give permission, as indicated by my signature below, for my child (the camper named above) to participate in Lake Beauty’s trail rides. I understand that signing below does not register my child for trail rides; rather, it gives permission for them to participate. I also understand that campers participating in horseback riding activities will be given introductory safety instructions before going on trail rides and that all riders will be required to wear protective head gear which the camp provides. It is my understanding that camp personnel seek to ensure a safe, educational, and fun program.

Signature _________________________________________________ (PARENT OR LEGAL GUARDIAN)DATE ________/________/________

� YES � NO

� YES � NO

� YES � NO

� YES � NO

Cost: $180, plus $5-10 cash for dinner on the ride up to camp. Includes transportation, program & meals at camp.

Registration Deadline: Oct 12, 2011

Scholarship forms available online at www.bereanbaptist.com/events

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Adventure Destination:Lake Beauty Bible CampLong Prairie, MN 56347-9734Phone 320.732.3218www.lbbc.com

Drop Off: At Berean ~ Thursday, Oct. 20 at 2:30 Pick Up: At Berean ~ Sunday, Oct. 23 at 2:30Both at Berean’s Main Entrance

Cost:

the best interest of my child in case of an emergency arising during the course of said minor’s attendance at the aforesaid function. I further understand and agree that my medical insurance coverage or other applicable insurance coverage, if any, are primary coverage for the protection of the child and that any insurance coverage provided by Berean Baptist Church are secondary coverage.

All participants must also have a “Berean Baptist Medical Consent” form on fi le at the church offi ce. They can be found on-line at www.epicsm.com. If you are unsure as to how to answer any of the questions, please contact us at 952.223.1847.

Signature _________________________________________________

DATE ________/________/________

EMERGENCY PHONE NO. (__________) ____________-______________

PAID:

� YES

� YES

� YES

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