PRESBYTERY OF NORTHERN KANSAS/HEARTLAND PRESBYTERY 2017 Fall Youth Retreat October 7-8 REGISTRATION MATERIALS

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PRESBYTERY OF NORTHERN KANSAS/HEARTLAND PRESBYTERY 2017 Fall Youth Retreat October 7-8 REGISTRATION MATERIALS TO REGISTER: 1. COMPLETE AND SIGN the paper Registration and Release form-page 3, OR you can register Online at http://conta.cc/2u1j1qs 1. SIGN the Covenant for Youth Events form-page 4 2. WRITE A CHECK PAYABLE TO HEARTLAND PRESBYTERY in the amount of: $65.00 if registration forms and payment are received by Heartland Presbytery or postmarked by September 1st, OR, $75.00 if received or postmarked after September 1 st. ***NOTE: ALL PAYMENTS ARE NON-REFUNDABLE*** 4. MAIL your Payment, the Youth Retreat Registration and Release form and the Covenant for Youth Events form to: Heartland Presbytery, 3210 Michigan, Ste. 200, Kansas City, MO 64109 60 YOUTH LIMIT: There is a limit of 60 youth participants for this trip based on a First Come, First Served with receipt of required registration forms and payment. WHAT YOU LL NEED FOR THIS TRIP: Overnight gear: sleeping bag pillow air mattress (optional) Personal Hygiene items: toothbrush & paste comb/brush deodorant bar soap, etc. Change of Clothes - and appropriate weather gear Flashlight One-piece swimsuit & Flip Flops for shower at local YMCA Money for Sunday Worship offering Closed Toe Shoes Work gloves Snacks to share (chips, candy, crackers, etc.) Bible Pen/notebook with paper IMPORTANT INFORMATION: When: October 7 8 th, 2017 beginning at 9 a.m. Saturday ending Sunday at 1:00 p.m. Who: All Middle/Junior High & High School students Where: Grandview Park Presbyterian Church, 1613 Wilson Blvd., Kansas City, MO. 6610 Why: Because we are called to be the body of Christ. Phone Contact: Grandview Park Presbyterian Church does not have a land-line telephone. Please contact Randy at 913. 302.4315 if you need to reach your youth Oct 7-8th. QUESTIONS? Contact: Presbytery of Northern Kansas at 800.511.0085 or Heartland Presbytery at 800.332.4849 Page 1

Saturday PRESBYTERY OF NORTHERN KANSAS/HEARTLAND PRESBYTERY 2017 Fall Youth Retreat October 7-8 (TENTATIVE) INTINERARY This schedule is subject to change based on weather and project availability. (NOTE: Please eat breakfast before you arrive.) 9:00 am Arrival/Registration/Check In 9:15 am Opening Activities/Get to Know You Activities 10:00 am History of Church & Community/Briefing of what will happen 11:00 am Lunch 11:30 am JUNIOR HIGH SENIOR HIGH Tour of local area Mural tours meaning and history of the murals Quindaro Township (Kansas a free state, where slaves stopped to rest, can probably get the museum opened up) Old Indian Cemetery Lewis and Clark point where Missouri and Kansas rivers meet Mission Work possibilities include Community garden Community center Big on social justice civil rights, immigration Clean up yards, etc. 2:00 pm JUNIOR HIGH SENIOR HIGH Mission Work possibilities include Community garden Community center Big on social justice civil rights, immigration Clean up yards, etc. Tour of local area Mural tours meaning and history of the murals Quindaro Township (Kansas a free state, where slaves stopped to rest, can probably get the museum opened up) Old Indian Cemetery Lewis and Clark point where Missouri and Kansas rivers meet 5:00 pm Clean Up 6:30-7:30pm Dinner at El Torito 8:00 pm Scripture/Reflection/songs 9:00 pm Large Group Activity 11:30 pm Lights Out Sunday 8:00 am Breakfast and pack up 8:30 am Reflection of weekend/scripture/songs 9:00 am Energizers, Games/Activities 10:00 am Bible Study with Rev. Rick Behren 11 12:30pm Bilingual Worship 12:30 pm Lunch 1:00 pm Depart/Sign Out Page 2

2017 Fall Youth Retreat October 7-8, 2017 Registration and Release Participant Name Grade M/F Church (City and Church) T-Shirts (Note: your paid registration must be postmarked by September 1st to receive a t-shirt.) Select size - youth large, adult small, adult med, adult large, adult XL, adult XXL PARENTS: By checking the box on the left, I grant permission for my child to receive text message updates about Youth events. Cell Phone Number (optional): By checking the box on the left, I grant permission for my child to receive email updates about PNK events. (optional) Email Address The youth named above has my permission to attend the 2017 Fall Youth Retreat in Kansas City, Missouri. I also release the church, adult sponsors, and the Presbytery of Northern Kansas from all liability, actual or potential, which arises from accidental injury to said minor or property, excepting liability for gross or willful negligence. Further, as parent and/or guardian, I authorize the treatment of my child by a qualified and licensed medical doctor in the event of a medical emergency. I understand that every effort will be made to reach me before any medical procedure is performed, unless it endangers my child s life, causes disfigurement, physical impairment, or undue discomfort should treatment be delayed. I grant permission to Presbytery to display any photos or videos from the 2017 Fall Youth Retreat that may include my child on its website and to promote future events. By checking this box, I request that any photo or video of my child NOT be used in publications. This release is completed and signed of my own free will. Parent/Guardian Printed Name Parent/Guardian Signature Date Home Address City Zip Emergency Phone Number(s) cell: home: work: Family Physician Name Family Physician Phone Insurance Company Policy # Group # Allergies / / Medications / / Page 3

Covenant for Youth Events During Presbyterian youth events we will be living together, youth and adults, in Christian community. Christian community is based on love, respect, trust, and support. Each of us, as members of the community, is important. By signing the Covenant, we promise to abide by the following guidelines for the life of this community. 1. The use of any tobacco products, alcohol, illegal drugs, or abusive substances will not be permitted during the event. 2. All participants will refrain from inappropriate sexual behavior. 3. Cooperative participation and respect for others is expected at all scheduled group activities and using electronic devices will not be permitted at these times. 4. Name badges, if distributed, will be worn at all times. 5. Persons will remain in assigned sleeping quarters at designated times. 6. Participants will refrain from disruptive behavior when asked to be quiet. 7. Youth will not leave the event or area unless in the company of a sponsor. 8. Everyone will respect each other's property. 9. No one will use unnecessary, vulgar or offensive language. 10. The use or possession of any firearms or knives or violating any law of the city or state will result in immediate dismissal and notification of appropriate authorities. 11. Everyone's dress and appearance will be appropriate at all times. How we look must "glorify God." (Questions and clarifications on this point should be directed to Youth Council adults.) I have read the Covenant for Youth Events and understand the following consequences: 1. Warning by adult sponsor. 2. Immediate consequence imposed by adult sponsors. 3. Leave the event immediately at the expense of the parents. If the decision is made to immediately send the offender home, a sponsor will first contact the parent(s) to determine the mode of transportation. The parent(s) may choose to personally pick up their child, or they may choose to be responsible for the cost of alternative transportation. The adult sponsors reserve the right to bypass any of the consequences depending on the severity of the infraction. Parent/Guardian s Printed Name Parent/Guardian s Signature Date Youth s Printed Name Youth s Signature Date Page 4