7th and 8th Grade Spring Retreat Registration and Off-Site Permission Form

Friday, March 14 at 6:00 pm through Saturday, March 15 at 9:00 pm at Camp Casey on Whidbey Island

Meet at Holy Spirit by 6:00 pm Friday night, March 14 - eat dinner before or bring a sack dinner. We’ll take the church shuttle to Whidbey Island, stay overnight at Camp Casey, and plan to return around 9:00 pm on Saturday, March 15. Cost is $150 and it covers meals, lodging, and transportation. Full or partial scholarships are available - talk to Tammie.

VERY IMPORTANT! We will also need a copy of your insurance card - please take a photo or make a copy and either include it with your payment, or e-mail it separately to Tammie Zarfos at confirmation@hslckirkland.org.

Register by signing up below, and placing your cash or check made out to HSLC (with "7/8 Spring Retreat" and student name on the memo line) in the registration slot at the counter in the Narthex. And please include a copy of your insurance card with your payment!

If you have any questions, please contact Tammie at confirmation@hslckirkland.org.

Name

First Name

Last Name

Preferred name

Grade

Allergies

Current medications

Other information we should know about your child for this event

This email address will be the one used to communicate important information about the event, so please use one that will be checked.

Parent/Guardian Name

Someone who can be reached during the event.

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone

(###)

###

####

I hereby give my permission for the person named above to participate in an off-site trip to Camp Casey on Whidbey Island from March 14 through March 15, 2025 (7th and 8th Grade Spring Retreat).

Enter your initials

In the event it becomes necessary for Holy Spirit Lutheran Church staff or volunteers to obtain emergency care for your youth, neither the staff, volunteers nor Holy Spirit Lutheran Church assumes financial liability for expenses incurred because of accident, injury, illness, and/or unforeseen circumstances.

Enter your initials

As parent, or legal guardian, I authorize a qualified physician to examine the above-named youth and in the event of injury to administer emergency care and to arrange for any consultation by a specialist, including a surgeon, as deemed necessary to insure proper care of any injury. I understand that every effort will be made to contact parent or guardian to explain the nature of the problem prior to any involved treatment.

Enter your initials

I understand the itinerary and that Holy Spirit Lutheran church will make every reasonable effort to provide a safe environment during this special event. As the parent/guardian of the above-named youth, I understand that there are inherent risks associated with participation in these activities including physical injury, and/or other consequences. I acknowledge that “Covenant of Conduct” rules of behavior apply during all special events.

Enter your initials

Parent/guardian name as a signature

Date

YYYY