Microsoft word - retreat brochure 08.doc

Dosage____________________________________________________
Name of medication______________________________________
Dosage____________________________________________________
Name of medication______________________________________
I give permission for the following medicatio
Only as needed for__________________________________
_________________ times a day starting _______________ a.m./p.m.
Only as needed for________________________________
_________________ times a day starting _______________ a.m./p.m.
following regarding your child's medication.
A camp designed for Students finishing the 6th – 12th grades.
Helping teens find the right connection.
Westwood Baptist Church
The Pier Student Ministry

Name (print) __________________________ Date_____________ Signature___________________________
or cause of action, past, present, or future
release, remiss and forever discharge the chaperones a
my child such medical care, treatment and hospitalization
I, the undersigned, do hereby consent to authorize and direct
Date of last tetanus shot __________________
Address ________________________________ City ________________________ Business Phone #__________
Business # ____________________________ Are you active in a
Address____________________________ City_________ State_____ Home # ___________________
Name__________________________ Age___ Grade___ Male Fe
______________ Phone # ___________________ Insurance Company _____________ Policy
need to be aware of: ______________________________________________
ncy, notify: Name _________________________ Phone #_______________
We have 112 beds available!
, arising out of any injury to my child.
Food ______________________________________________
Dietary restrictions ____________________________
Sheets & Blanket or sleeping bag, Pillow, Aqua Shoes or
Flip Flops, Long pants for worship service or dress, 1
Piece swimsuits for girls, Old Cloths for the Games, Bath
the chaperones of Westwood Baptist Church to obtain for
& personal hygiene items, Towels & wash cloths,
Sunscreen, Money for 1 meal on the way to Panama City
and one meal on the way back, plus any spending money
Bible & pens (notebook will be provided)
A Good ATTITUDE!
****Limit luggage to 1 large suitcase & 1 carry on
Do Not to bring
Any illegal drugs, Alcohol, or tobacco products. No non-Christian music. (No secular music. Only what Glorifies God), and weapons of
Source: http://www.westwoodbaptist.net/the_files/pdfs/retreat_brochure_08.pdf
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