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Register Now for Winter Blast 2012!

Name ____________________________________

Phone ___________________________________

Grade ___________________________________

Male r Female rStudent r Sponsor r

Youth Leader:Keep this form for your records. Do not submit this form to the retreat registrar. Youth leaders questionsabout registration can be directed to Sonya Lorntson at 515-460-0226 or winterblastRSCD@gmail.com

Cost and Registration DeadlinesRegistration Deadline: Registration must be givento your youth leader by January , 2012

Retreat Cost: $

Late Fee: After January 19, 2012 there will be alate registration fee of $20 per student

HiddenAcresChristianCenterFebruary3-5,2012

Fill out this registration and the health form on the reverse side and give it toyour youth leader along with the payment amount they have given you.

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Zach is a full time worship intern at

First E-Free in Ames. He graduated

last May with a BA in Music and a

minor in Religion from Iowa State

University. He has been involved

in worship bands for the last eight

years and has been leading worship

for the last three years. Zach hopes

to be a full-time worship director at

a church within the next year. He

has been married to Jenna for two

and a half years.

Winter Blast Medical Permission Form

I ______________________________________________

(The parent or guardian)

do give permission to

_______________________________________________(Students name)

To participate in the Winter Blast Retreat held at

the Hidden Acres Christian Center on Feb. 3-5,

2012. Should emergency medical treatment benecessary. I authorize one of the adult leaders to

act on my behalf and approve the appropriatetreatment.

Parents Contact #s ___________________________

_______________________________________________

Date _________________________________________

Insurance Company _________________________

______________________________________________

Policy # ______________________________________

Other Medical Information ___________________

______________________________________________

______________________________________________

______________________________________________

Students: Submit this form and a check madeout to your host church to your youth leader.Deposits are non-refundable but transferable to

another person of the same gender from yourgroup.

I was born and raised in Ames, IA,

graduated college from UNI and

currently work at a church in Cedar Falls,

IA. I work with High School Students and

absolutely love my job! I just got married

to the love of my life. I grew up going to

Winter Blasts and loved every minute ofem! Im on team Jacob, team speedos,

and I like skittles too. Finally, I absolutely

love Jesus and everyday seek to live my

life for Him.

Bible/Penq

Sleeping Bag/Pillowq

Spending Moneyq

Winter Clothesq

Clothes That Can Get Dirtyq

Towel/Toiletriesq

Positive AttitudeqSwimsuit/Trunks (onlyq

modest swimwearallowed)

Sorry - No iPods, CDqplayers, electronic games,

student cell phones etc.

Winter Blast is an annual 6-8th grade retreat sponsored by RSCD (Reach Students Central Distr ict of the Evangelical Free Church)

Registration begins at 6:30 p.m. on Friday inthe Welcome Center (1st session at 8:15 p.m.)

Retreat ends Sunday at 11:00 a.m.

In case of emergency, students may bereached at 515.547.2751

Winter Activitiesq

Gymnasiumq

Game Roomq

Snack Barq

Swimming Poolq

and Hot Tub

Complete both sides of this form

Speaker:Kyle Thomas

Worship:Zach Brenner

To Bring: To Do: