DEEP FREEZE 2014!!

January 17-19, 2014

LOCATION: Camp Crossroads Torrance, Ontario COST: $85 per person *Talk to Mark if money is an issue make cheques out to Scott St. MB Church CONTACT: Mark Durksen if you have any questions: ! ! ! ! Mark@ScottStChurch.ca or 905.937.6900
What to Bring: Sleeping bag, pillow Warm clothing Towel, toothbrush, toothpaste, soap, etc. Winter boots, warm jacket, snow pants, gloves, scarf, toque Flashlight Bible, notebook, pen What Not to Bring Electronic devices (audio players, video games, etc.) Alcohol, illegal substances Matches, lighters, etc.

Regarding cell phones Camp Crossroads is a place to disconnect yourself from the pressures and busyness of everyday life. As such, students will not be allowed to keep cell phones with them during their stay. If a student brings a cell phone (s)he must hand it in to a leader upon arrival to Camp Crossroads. It will be given back to them upon departure from Camp Crossroads. Neither Camp Crossroads, NEMBY, nor any affiliated staff or volunteers are responsible for any lost or stolen articles, including cell phones. If there is an emergency and you need to contact your child you may call Camp Crossroads at 705-762-3111. Also, adult leaders Mark Durksen and Sabrina Wiens will carry cell phones with them in case of emergency. You may request their numbers beforehand. If your child needs to contact you, they may use Camp Crossroads phone to do so. ----------------------------------------------------------------------------Name: _____________________________________________________ Age: _________ Birth Date: ____________________ Health Card #: _____________________________ Allergies: ____________________________________________________ Medications: ____________________________________________________________________________________________ Parent/Guardian Name(s): _________________________________________________________________________________ Home Phone #: _______________________________________ Cell #: ____________________________________________ Address: _________________________________________ City: _________________________ Postal Code: ____________ Family Doctor Name: _________________________________________ Dr.s Phone: ________________________________

IMPORTANT: Forms and money need to be in by Thursday, December 19!

Student Co-operation Agreement We are glad that you are coming on the retreat and we hope that you will have a great time, enjoy your friends and learn more about God and your relationship with Him. To keep things enjoyable for everyone, there are a few simple guidelines to remember and live by: Follow all Camp Crossroads rules and guidelines. Be respectful of others and their property, if you break something you pay for it. Be back in your sleeping area and quiet by the designated time. Do not wander off alone. Attend all group functions. I have read the above Co-operation Agreement and, by signing below, agree to abide by it. Student Signature: ______________________________ Date Signed: ___________________________

Parental Permission I give my permission for the above named youth to participate in Deep Freeze 2014. I understand that all reasonable safety precautions will be taken at all times by NEMBY leaders during the event described above. I understand the possibility of unforeseen hazards and know the possibilities of risk. I agree not to hold Scott St., Fairview, or Grantham MB Churches or their employees or volunteers liable for damages, losses or injuries incurred to the subject of this form. In event of an emergency, I hereby authorize an adult leader as agent for me, to consent to any X-ray examination, medical, dental or surgical diagnosis, treatment, and hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the law of Ontario where the services are rendered, either at a doctors office or in a hospital. I expect to be contacted as soon as possible in this event. Signature of Parent/Guardian: _____________________________ Date signed: __________________