Lutheran Valley Retreat July 23-30 2016

Our Savior Lutheran Church

What is the trip about….This summer Sr. High youth get an amazing

opportunity to travel to Colorado to Lutheran Valley Retreat and spend a week getting time to reflect in God’s Word, build relationships with others, and get a chance to serve by working with handicap campers providing them with a camp experience.

The youth will be headed to LVR July 23-30 at LVR. Youth will enjoy a week reflecting on God’s Word through Bible Study and nature, spend time building relationships with Our Savior youth and other youth groups, and serve others with special needs. Youth will also get to enjoy activities offered by LVR such as hiking, rock-climbing, archery, fishing, bouldering, and much more.

This trip is open to youth going into 9th grade fall of ’16 thru high school graduates spring ’16. This is a great

opportunity not only for the youth to serve others but to also grow in their faith and in fellowship with one another.

LVR Schedule *tentative July 23rd

8:00amo Depart from Our Savior Lutheran Parking lot

5:00pmo Arrive in Denver, Check into hotel * Something fun in Denver

10:30pm o Devotions

11:00pmo Lights Out

July 24th 9:30am

o Church in Denver, CO 12:00pm

o Lunch 1:00pm

o Depart for LVR 4:00pm

o Arrive at LVR

July 25th – 29th LVR Schedule

July 30th 6:00am

o Clean/Pack

7:00amo Depart for Norfolk

10:00pmo Arrive in Norfolk, NE at Our Savior Lutheran Church

LVR Planning Team

DEADLINESDeposits:

$50 deposit and Commitment Form due at registration (November 15th).

Monthly $100 deposits by the 1st of the month for January, April, May and June. Remaining balance

due July 1st. Total $480

Forms OSL Commitment/Registration due Nov 15th LVR Medical & OSL Medical Form due July 1st

Contact Information

LVR P.O. Box 9042Woodland Park, CO 80866Tel: 719-687-3560

Christine Ekbergdcechristine@oursav.org402-860-0725

Participants:TBD

A Few Fun Our Savior Guidelines Guidelines

Respect GodRespect OthersRespect Yourself

1. No possession or use of alcohol, drugs, tobacco, or weapons2. No offensive or immodest clothing 3. No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters4. Participation with the group and comply with event schedules is expected5. Respect for adult leaders (OSL and other adults) is expected6. Cell Phones acceptable in moderation, they WILL NOT work at camp.

Discipline: Scale of discipline dependent on severity of circumstance, warnings will be in given. If a child is subject to be sent home, the decision will be made by youth’s main leader for their church, cost for flight home will be on the family.

What to Bring: (OSL guidelines)T-shirts/Tank tops (Tanks – 1 ½inch straps) Shorts or Pants (shorts at least a 4 inch inseam) Alarm clock (watch, you can’t use your phone)

Lutheran Valley RetreatSummer CampThings To Bring

Bible & Pencil or Pen Towel & Washcloth Sleeping Bag or Bedding (At least 40 degree) Soap & Shampoo Pillow Toothbrush & Toothpaste Clothing for Sleeping Comb or Brush Pants Shower Sandals Shorts (at least 1 per day)

Chapstick & Sun Screen

Sturdy Shoes (at least 1 pair will get dirty) Shirts (at least 1 per day)

Day Pack Hat or Cap

Things NOT To Bring

MP 3 players/I-pods, Knives, Fire Works, Curling Irons, or Blow DryersGum, Sling Shots, Cell Phones (they don’t work @ LVR anyway).

The Camp StoreWhile at Lutheran Valley Retreat you will have the opportunity to use the Camp Store. At the

Camp Store you will be able to purchase snacks and drinks at $.75 each. There are also Shirts, Sweatshirts, Hats, Bandanas, Water Bottles, and much, much more. Items are priced from $3 up

to $40.

LUTHERAN VALLEY RETREAT CONTACT AND HEALTH HISTORY FORM

Dates of Camp Session ________________

Name _______________________________________ Birthdate _______________ Circle M/F

Address _________________________ ____________ City/State/Zip ________________________________

Parent Name __________________________________ Home Phone Number _________________________

Place of Employment ___________________________ Work Phone _________________________________

E-Mail _______________________________________ Cell Phone __________________________________

Parent Name __________________________________ Home Phone Number _________________________

Place of Employment ___________________________ Work Phone _________________________________

E-Mail _______________________________________ Cell Phone __________________________________

Emergency Contact Name _______________________ Relationship to Camper _______________________

Emergency Contact Address ______________________ Emergency Contact Phone _____________________

Family Medical Insurance Company ______________ Insurance Phone ____________________________

Insurance Address______________________________ Insurance City/State/Zip______________________

Parent Permission & EndorsementThis health history is correct so far as I know & the child herein descried has permission to engage in all prescribed activities including, without limitation, climbing/rappelling, equine, low and high ropes courses, rafting, and walking or riding in camp vehicles, except ________________________________________.I understand that many of these activities are limited to 11 year and older youth. I hereby assume the risk of all injuries to the person herein described & I release and discharge Lutheran Valley Retreat, its agents and employees from any and all liability that results from injury to the person herein described. Insurance protection is my responsibility. I give permission for the camp to administer medications as it deems necessary to this child, including medications sent with my child or nonprescription medications available at camp. In the case of an emergency, I know every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission for the medic selected by the camp director to hospitalize and secure proper treatment for my child. I assume financial responsibility for actions that may cause damage to property.If the staff deems it necessary for my child to be removed from camp, due to disciplinary or other problems I will respond by promptly picking up my child from camp.

Signature of Parent/Guardian _____________________________ Date______________________

Dates of Camp Session ________________Camper Name__________________________Lutheran Valley Retreat requires every camper to have a physical within 12 months prior to their camp session; doctor may sign a photocopy of this form, but all signatures must be original and include camper's name.

Height: ________________ Weight:_________________ Blood Pressure: __________________

Current Medication: Please not, all prescription MUST be prescribed to this individual, within expiration date, and in their original packaging

Name of Medication Reason for taking Dosage Schedule

Health History

Condition Circle one If Yes: Condition Circle

one If Yes: Condition Circle one If Yes: Condition Circle

one If Yes: Conditions Circle one If Yes:

Anxiety or depression

No

Yes

Current

PastRecurrent Headaches

No

Yes

Current

Past

Heart Disease or problems

No

Yes

Current

PastDiabetes

No

Yes

Current

Past

ADD or

ADHD

No

Yes

Current

Past

EpilepsyNo

Yes

Current

PastAsthma

No

Yes

Current

PastFrequent

ColdsNo

Yes

Current

Past

Frequent Ear

Infections

No

Yes

Current

PastBed

WettingNo

Yes

Current

Past

Ear, Nose, or Throat Trouble

No

Yes

Current

Past

Disease or injury to joints or

back

No

YesCurrent

Past

Stomach or intestine

trouble

No

Yes

Current

Past

Dizzy Spells or Fainting

No

Yes

Current

PastHome

SicknessNo

Yes

Current

Past

Eating Disorders

No

Yes

Current

Past

Comments, other issues, physical limitations and/or list surgeris

Allergies/Dietary Needs

Type of Allergy Circle Describe/Specify Allergen Mild

(runny nose, sneezing)

Moderate

(Swelling or severe rash)

Severe

(System Response/Difficulty breathing)

Food No Yes

Medication No Yes

Environmental (animal, insect, etc.) No Yes

Other No Yes

Vegetarian? No Yes Limitations: Gluten Allergy? No Yes Limitations: Lactose Intolerant? No Yes Limitations:

Immunizations

Vaccination Most Recent Date

Vaccination Most Recent Date

Vaccination

Most Recent Date Vaccination Most Recent Date

Vaccination Most Recent Date

Measles, Mumps, Rubella (MMR)

Hepatitis A HIB Chicken Pox (or had the disease)

Influenza

Diptheria/Tetanus (DPT)

Hepatitis B Polio Other Other

I have examined and found camper to be in satisfactory physical condition, free from any contagious desease and capable of active participation in a regular camp program at altitudes of 8,400-9,100 feet above seal level except as follows____________________________

The camper is under the care of a physician for the following condition(s):_____________________________________________________

Licensed Phsician's Signature________________________ Date of Examination___________________________________________

Doctor Name___________________________________ Doctor Phone __________________________________________________Doctor Address_______________________________________________________________________________________________

Doctor City/State/Zip__________________________________________________________________________________________Official Use only (camp staff only to be determined on site): The camper appears to be healthy and free of contagious desease and capable of active participation for all camp activities. Circle one Yes No

OUR SAVIOR COMMITMENT FORM LVR 2016

Motivated by God’s love for me, I, __________________________________, commit to exploring, sharing, and growing in my faith this year. As a part of the Our Savior Lutheran Youth Group I plan to attend the summer servant event to Lutheran Valley Retreat, Woodland Park, Colorado.

Parent YouthInitials Initials

_____ _____ I understand the spiritual, financial, and personal conduct expectations that are a part of this trip. I also understand this deposit is non-refundable. If an unavoidable circumstance causes me to not attend the trip, I know that I will not be refunded any payments made toward the trip and will not be held responsible for any remaining payments.

_____ _____ Throughout this experience we will be intentional about sharing God’s love with others through both our actions and our words. I will build relationships with fellow youth, serve my peers, and strengthen our youth group by being actively involved in worship and Senior High Youth Group and/or Formula 3:18 before and after the trip. (Minimum of 7 youth Bible Studies between now and the trip.)

_____ _____ It is the work of many people to coordinate and prepare for the this trip. I will do my part by attending the required bible studies and training prior to the trip scheduled for TBA April or May.

With my signature affixed below, I hereby give permission for my child, ______________________________, to attend Lutheran Valley Retreat summer trip. This signed agreement hereby absolves the volunteer sponsors, Our Savior, the church staff, and any and all members of its governing boards of any responsibility for the safety, welfare, health, and well-being for the above mentioned child beyond such matters as may be called reasonable care for youth in the care of a sponsor, and subject to the sponsor’s clear instructions. The undersigned also assumes, personally and exclusively, all responsibility and liability for accident, injury, or other misfortune which may occur to the above-named child during the time of this activity.

My child agrees to behave responsibly according to the laws of the State, the rules of Our Savior Lutheran Church and the reasonable expectations of the adult sponsors.

I also affirm that my child has the following items up to date and on file at Our Savior Lutheran Church but June 1 2016: Emergency Medical Release From LVR Medical Form

$50 deposit and Commitment Form due at registration (November 15th ).$50 monthly deposits due the 1st of January, Apr, May, Jun and remaining balance due July1. Total $480

_____________________________________________ __________________________Youth Signature Date

_____________________________________________ __________________________Parent Signature Date