MEDICAL AUTHORIZATION FORM
ST. JOHN'S WINDISH & ST. PETER'S LUTHERAN CHURCH
JOINT YOUTH RETREAT AT WILDWOOD, NJ
June 27 - 29, 2008
This form authorizes a licensed physician, surgeon, or other recognized medically trained person (EMT, nurse, etc.) to carry out emergency medical care deemed necessary for any child/ward in an emergency when normal permission is unavailable. This form also lists all medical conditions of said child/ward known to me. Finally, it lists all medicines that this child/ward must take while in the care of the chaperones on the Youth Retreat. I understand that no child/ward will be permitted to keep any over the counter medicines or prescription drugs in their possession or in their room. All medicines will be kept and administered by adult chaperones.
| ______________________________ | __________________________________ |
|---|---|
signature of parent/guardian |
signature of parent/guardian |
Name of child _______________________________
Address ____________________________________________
City/State/Zip Code_______________________________________
Family physician _______________________ Phone ____________________________
Insurance Co. _______________________ Policy # ________________________
In case of an emergency, please notify _____________________________
at this phone number _________________________
Medical conditions of child as known to parent/guardian:
Medicines and dosage to be administered to child by adult chaperones:
GUIDELINES FOR YOUTH RETREAT - 2008
To help the smooth order of the short retreat weekend, the following guidelines have been developed for those participating in the retreat experience at The Luther Inn of the Lutheran Church of the Holy Trinity, 2810 Atlantic Ave., Wildwood, NJ 08260 (609-522-5000).
1. All youth will be expected to participate in the setting up, cooking, and cleaning up of meals as directed by the adults in charge of the kitchen and dining areas. Each room will be assigned particular meal assignments by the kitchen staff. Assignments will be posted in the kitchen area and will be announced at the meal prior to service.
2. Free time will be offered on both the beach and the boardwalk. Strict regulations of such free time will be observed. Failure to observe these regulations may lead to disciplinary action, including dismissal from the retreat experience. These regulations include:
--All participants will go to the beach as a group and swim in the same general area (chosen by the retreat chaperones).
--Free time on the boardwalk will observe certain parameters defined by the chaperones at the retreat site (e.g. 6:45 to 9:45 PM). These time parameters must be strictly observed. When the group is told to reassemble at a particular time and at a particular place, every participant will be expected to be at that place at that time! There will be no exceptions.
3. All snacks will be provided. Individuals are not permitted to bring their own private snacks. Absolutely no foodstuffs of any kind will be permitted in rooms. Snacks, etc. may only be eaten in areas designated by the chaperones.
4. Do not over-pack for the retreat. Each participant will only be allowed one piece of luggage (remember... we're only going to be gone for the weekend!). It is also strongly suggested that 'soft luggage' (e.g. duffel bags, gym bags, 'soft' suitcases, etc.) be utilized if at all possible. Do not bring large, solid luggage if you can avoid it! (Girls- please consider sharing large items like hair dryers, etc. with one or more of your friends.) Remember toiletries, sun block, beach footware for hot sand (sandals, flip flops, moccasins, beach shoes, etc.), swim suits, towels (for both beach and for showering), shorts, summer weight shirts and blouses, blue jeans or slacks and a sweatshirt, sweater or jacket in case of a cool evening on the boardwalk, an umbrella (just in case!) and something presentable to wear to worship at the Holy Trinity Lutheran Church on Sunday morning (it doesn't have to be a suit or dress, but it should be something good enough to present to the Lord!).
5. Every participant will be expected to be at each and every retreat session.
6. Every participant will be expected to accompany the group to worship at Holy Trinity on Sunday morning. Proper behavior during worship will also be expected.
7. Any damage done to property caused by retreat participants will be at the expense of the participant involved (and their parents).
8. Contrary to the policy in previous years, cell phones are now permitted on the retreat. While we are together as a group, they are to be used ONLY in emergencies.
9. Participants will be allowed to bring small radios, tape players, CD players, or iPods for beach and room use. Please use headphones when possible - not everyone may want to listen to your choice of music! Excessive volume (as defined by the chaperones) will not be tolerated.
10. A Medical Authorization Form will be provided to parents or guardians prior to the retreat. All medical conditions and medicines, allergies, etc. of participants are to be listed and detailed on that Medical Authorization Form. We expect to have a nurse or other trained medical person among our chaperones. 'Meds' are to be clearly labeled and listed on the Authorization Form (name of participant, name of drug, dosage, time to be administered, etc.) and given to the chaperones to be administered by them.
No prescription drugs or over the counter medicines will be allowed in any participant's room!
11. Use of alcohol or any other controlled substance by any participant is obviously strictly prohibited. Ignoring this regulation will result in the immediate expulsion of the offender from the retreat. There will be no exceptions to this rule.
12. The cost of the retreat is $85 per person. Since this year's retreat ihas not been underwritted by any individual or group, all persons participating are expected to pay the full retreat cost. This will cover lodging and all but the one meal on the boardwalk. The cost of the transportation via Easton Coach Bus Company is being shared and covered by the congregations. The retreat cost has been increased slightly (from $80 per person in previous years) due to the increase in food costs. Checks should be made out to St. Peter's Lutheran Church.
13. Participants will need money to buy supper on Friday night on the boardwalk, 'spending money' for any boardwalk activities (snacks, games, Saturday morning bike rental, etc.), and offering money for Sunday morning worship at Holy Trinity.
14. 10:30PM to midnight each evening will be considered 'cooling down time'. No running, yelling, excessive activity, loud radios, etc. either in the rooms or outside will not be permitted. This will be time for reading, quiet conversation, card games, etc. Out of courtesy for the neighbors, the Luther Inn requires that there by NO LOUD NOISE outside after 11:00PM. All participants will be in their rooms and quiet with lights out at midnight! There will be no exceptions.
15. The Luther Inn does not provide towels, pillows, sheets or linens. Therefore, each participant is to bring a pillow and sleeping bag or bedroll with them. That failing, please bring pillow, sheets and blanket.
16. Improper behavior will lead to disciplinary actions by the chaperones which can include warning, 'grounding', call to parents, expulsion from he retreat. Chaperones will decide the appropriate response to each infraction.
17. Each participant must return both a Medical Authorization Form and a Permission Slip that is filled out and signed by their parent or guardian prior to the retreat in order to go on the retreat. No one will be allowed on the retreat without these two forms. Separate forms must be filled out for each child from the same household attending the retreat.
18. All forms and money (checks, made payable to St. Peter's Lutheran Church) must be turned in to your Pastor no later than Sunday, June 8.
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(detach and return by June 8, 2008)
PERMISSION SLIP
For Joint Wildwood NJ Retreat - June 27-29, 2008
St. John's Windish and St. Peter's (Hanover Ave.) Lutheran Churches
I give permission for ____________________________ to attend the youth retreat to be held at The Luther Inn in Wildwood, NJ (Holy Trinity Lutheran Church) from June 27-29, 2008.
___________________________________________
Parent/Guardian Signature
In the event of an emergency over this weekend, I can be reached at:
Name of Parent/Guardian____________________________
Address ___________________________________________
Phone:_______________________ Cell phone:_______________________