Substance Youth Winter Retreat. February 24-25, 2017 Burtrum, MN

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1 What: Winter Retreat is a weekend for Substance Youth Students to gather together to worship God, listen to inspiring messages & have fun connecting with other students & leaders. Substance Worship will be doing the music & one of our Substance pastors will be the speaker! Who: All students grades 6-12 th grade! (and their friends) When: (5pm Friday 11:30pm Saturday night) - Plan to arrive at the Substance Northtown Campus (8299 Central Ave NE Spring Lake Park, MN 55432) by 5pm Friday, February 24 th. - Pick up will be late Saturday night at 11:30pm (at the NTN Campus) Where: Camp Lebanon, 1205 Acorn Rd, Cost: Early bird rate: $125 fee + $10 cash (for dinner Friday night) * register by Sunday February 5 th Last minute rate: $140 fee + $10 cash (for dinner Friday night) * register by Sunday February 19 Cost covers Camp Lebanon facilities, transportation, meals & snacks. - A non-refundable deposit of $45 is due with registration & remaining payment is due by February 19 th. - Make checks payable to Substance Church & write Youth Winter Retreat in the memo line. - if finances are an issue, contact Parice Bayer to discuss scholarship options. (parice.bayer@substancechurch.com)

2 How to Register : Turn in completed registration form & $45 non-refundable deposit by one of the following methods: 1. at our Sunday night small groups (when you check in) 2. mail to our Substance offices Substance Church Attn: Parice Bayer, Substance Youth 8299 Central Ave NE Spring Lake Park, MN Schedule of Retreat: Friday (February 24) 5:00pm students arrive at our Northtown Campus 5:30 bus departs for Camp Lebanon * bring $10 for dinner on the road 8:00 arrive at Camp Lebanon 8:30 Evening Session: worship & speaker 11:00 Late night snack / activities 12:00 Lights out Saturday (February 25) 8:30 breakfast 10:00 morning session: worship & speaker 12:30 lunch 1:30 5 free time: indoor & outdoor activities 5:30 dinner 7:30 Evening session: worship & speaker 9:30 pack up & head home 11:30 arrive at Northtown Campus for pick up Packing List: * comfy modest clothing * pajamas * winter gear: boots, snow pants, hats, gloves (make sure they are labeled in a bag) * toiletries (deodorant, toothbrush, toothpaste, shampoo, conditioner, towel) * sleeping bag / sheets / pillow / blanket * Bible, journal, pens / pencils * money for dinner Friday night ($10) * optional money for souvenirs etc at Camp Lebanon store

3 Expectations: 1. Be where you re supposed to be. This includes arriving to the events on time & staying within the boundaries set for you by the leadership. 2. Respect people & property Whether we are on the church campus or off, uncooperative, unkind or destructive behavior towards people or property will not be tolerated. Any damages will be paid by those responsible. 3. The purple rule is in effect. - Guys are blue. Girls are pink. No making purple. Enough said. - no guys in girls rooms, no girls in guys rooms. 4. The following items are not allowed and will be confiscated: - electronics (computers, tablets, ipads, video games) - pornography / questionable reading material - fireworks for weapons (including knives) - drugs, alcohol or tobacco products * students may bring cell phones but limited usage will be permitted. 5. Come expectant - plan on making friends - plan on connecting with Substance youth leaders - plan on strengthening your relationship with God & faith

4 Substance Youth Winter Registration & Medical Release PLEASE PRINT CLEARLY. FORM & DEPOSIT DUE BY FEBRUARY 19th, Student Information Name: Phone Number: Circle: M / F Birth Date / / Grade 2. Parent/Guardian Information Parent(s)/Guardian(s): Home Phone: Cell Phone: Address: Mailing Address: City/State/Zip: 3. Emergency Contact (other than parent/guardian) Name: Phone Number: Relationship: 4. Medical Information Clinic/Doctor: Phone Number: Family Insurance Company: Policy & ID#: Please provide copy of insurance card (Electronic copies may be ed to youth@substancechurch.com ) Last tetanus shot (month/year): Health Concerns/Limitations: Allergies: 5. Medications My child can receive the following as deemed necessary (circle): Tylenol / ibuprofen / antacids / None Prescription Medication(s): Name Dose Time of day: All medication, including non-prescription drugs MUST be turned into Substance Youth staff upon arrival in the ORIGINAL container. NO medications will be accepted loose in a bag or in a pill dispenser. The name of the student MUST be on each prescription package.

5 6. Medical and Liability Release I give permission for my student to attend Substance Youth, February 24th - 25th, 2017 and to participate in its activities. I, acting on my own behalf release Substance Church and/or Camp Lebanon including staff as well as volunteer workers from any liability whatsoever arising out of property damage or loss as well as any injury, sickness or death which may be sustained by my student as the result of any participation in Winter Retreat. I am aware of the risks associated with participating in Winter Retreat and accept my student s participation with full awareness of these risks. I give permission for the Substance Church designated medical personnel to treat my student in the event of a minor illness or minor injury. In case of an emergency, and I am unable to be contacted, I hereby give permission to the local physician selected by Substance Church to hospitalize, secure proper treatment for, order injection, anesthesia, or surgery for my student. I give permission for my student to be interviewed, identified, and/or photographed, filmed for use in publications including but not limited to website, social media, and promotional videos. I have read and agree to the medical and liability release and the student expectations. I understand that if my student misbehaves and violates the Substance Youth and/or Camp Lebanon expectations, I may be called to pick him/her up. Parent/Guardian Printed Name: Date: \ \ Parent/Guardian Signature: Date: \ \ 7. Student Agreement I have read and agree to Substance Youth and Camp Lebanon expectations: Student Signature: Date: \ \ Registration Insurance Card For Office Use Only: Deposit Remaining Payment Scholarship

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