Information and Release Forms Available for Download Or at the Kids Booth

Activities will include: Bible studies, worship, canoeing, rifle range, archery, climbing wall, pamper pole, vertical playpen, camp fire, games, OMC (organized mass chaos) and more!!

Kids will be spending the night at a cost of $55. This cost covers lodging, activities, meals, snacks, transportation and a t-shirt. Chaperones are asked to pay $30 to cover some of the costs. The first 42 campers and 8 adults to sign up online are guaranteed a spot. You must pay in full when you register your child or yourself for the retreat. We will meet Saturday morning the 26th at 8:00am at church in the Harbor. We will participate in Sunday morning worship, the 27th, at Camp Chandler and will return to our church in the Harbor around 12:00pm.

Information and release forms available for download or at the Kids’ booth. Please turn in release forms to black box on wall across from Kids’ Booth or mail to Coosada Baptist, c/o Lauri Cox, P.O. Box 99, Coosada, AL 36020.

Payments can be dropped in the black box across from the Kids’ Life Booth, or payment of $57 can be made online ($2 more for processing charge).

Registration (ONLINE), releases and payment deadline is Sunday, September 6th!

Fall Retreat Campers Things to Bring: Bible Sleeping Bag and/or sheet set and blanket Pillow Flashlight Toiletries One towel and washrag Pajamas

2 Changes of Clothes *one set of old clothes for Organized Mass Chaos & a plastic bag to put these clothes in after OMC Tennis Shoes

Meet at the church in The Harbor at 8:00am Saturday morning the 26th. We will return to church Sunday morning, the 27th, to the Fellowship Hall around 12:00 noon.

Emergency Number while at Camp Chandler Lauri’s Cell (334) 224-1540

YMCA HOLD HARMLESS AGREEMENT

STATE OF ALABAMA, ______(COUNTY) I, ______, as the parent or guardian for (Parent’s Name) ______, a minor child who is in my care a (Child’s Name) custody, do hereby grant my permission for my child to attend a program or event at YMCA

Camp Chandler. I fully understand the nature of camping and recreational activities associated with the use of the camp facilities and/or programs includes an inherent risk of danger, which may result in personal injury or harm to my child. I understand that my child will be under adult supervision at all times but, notwithstanding any level or degree of supervision, that accidents may occur which may result in physical injury or harm to my child. It is with the full understanding of the risks associated with these types of activities that I grant permission for my child to participate in the program to be conducted at YMCA Camp Chandler, and I agree to indemnify and hold harmless YMCA Camp Chandler, the Montgomery Metro YMCA, its staff, directors, employees, agents and/or representatives from any claim for any injury or damage which may result from my child’s attendance and participation in the program conducted on camp property. Permission is granted for my child to participate and I understand that by signing this form I am voluntarily and knowingly accepting responsibility for my child’s participation in the activity or program to be conducted at YMCA Camp Chandler. I also grant permission for pictures and images of my child to be taken while participating in activities and used for YMCA promotional purposes.

Dated this ______day of ______, 2015.

Parent’s Signature: ______

Notary Signature______

My Commission Expires on ______

Coosada Baptist Church Fall Retreat Medical Release Form 2015 Child’s Name: ______Grade: ______

Parent or Guardians Name: ______

Address: ______City: ______Zip: ______

Home Phone: ______Work: ______Cell: ______

Another person to contact in case of emergency if you cannot be reached:

Name: ______Relationship: ______

Home Phone: ______Work: ______Cell: ______

Please list any allergies to foods, medicines, insect bites, etc. or any other medical conditions that we need to know about: ______

Family Physician: ______Phone: ______

Insurance Co.______Policy #______

Group #______

Name on Card and DOB: ______

I hereby give permission for my child______to go to Camp Chandler in Wetumpka, Al, with Coosada Baptist Church for Fall Retreat. Further I give my consent for the church representatives in charge to obtain necessary medical attention and treatment in case of sickness or injury to my child. I, the undersigned, do hereby verify that the above information is correct and I do hereby release, and forever discharge all sponsors of Coosada Baptist Church from any and all claims, demands, actions or cause of action, past, present or future arising out of any damage or injury while participating in Fall Retreat September 26th – 27th, 2015

Dated this______day of______2015

Signature of Parent or Guardian______

Notary Signature______

My Commission Expires on ______