ROCK THE UNIVERSE DETAILS

September 10th-12th

Cost: $88

Deadline: Sunday, September 5

Permission slip and money to be turned in together

Arrive: Friday Sept 10th @ 3:00pm or as soon as you can get to the
church
Depart: Friday Sept 10th @ 3:30pm @ Baymeadows Baptist Church
Return: Sunday Sept 12th @4:00pm @ Baymeadows Baptist Church
(We’ll keep you updated if this changes)

Additional Info:

Hotel Information:
Champions World Resort
8660 West Irlo Bronson Memorial Highway
(A.K.A West US-192)
Kissimmee, Florida 34747
Local: 407.396.4500 ext 1

Pizza and drinks will be provided at the church @ 3:00. We will also be
loading the Vehicle at this time.

Additional money is needed for snacks, food, drinks, or souvenirs.

Contact Numbers:

Student Pastor: Will Reichley- 407.595.0637

Chaperone: Dawn Reichley- 407.595.0656

Chaperone: Shannon Renee- 904.252.3289

 Permission Form

I, the undersigned parent or guardian, hereby consent to my child, _________________________ going

to ROCK THE UNIVERSE, ORLANDO, FLORIDA sponsored by Baymeadows Baptist Church on
September 10th-12th,2010.

I certify that my child is able to participate in this activity. If my child has medical conditions which may be
relevant to a physician in the event of an emergency, I have listed them below. If I cannot be reached, I
hereby authorize any chaperone of this event to make emergency medical decisions for my child as
stated in the medical release form. If there are any activities I do not want my child to be involved in, I
have listed then on this form.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL THE RISKS WHICH MAY BE
ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT
THERETO. I do hereby agree to hold Baymeadows Baptist Church and its agents and employees,
harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account
of injury to my child or property, even injury resulting in death with the activity or participation in any other
associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive
as permitted by the law of the state of FLORIDA and that if any portion thereof is held invalid, it is agreed
that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the
entire agreement between the parties hereto the terms of release are contractual and not a mere recital.

I also understand that I am giving permission for my child to be photographed or videoed in this single
event.

I certify that my child is able to ride in the designated church transportation to and from the event.
This transportation includes but not limited to the church van of Baymeadows Baptist Church, rental
vehicles, charter busses, personal vehicles of approved leaders, and other such transportation.

I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE
CONTENTS THEREOF AND I SIGH THIS RELEASE AS MY OWN FREE ACT. This is a legally binding
agreement which I have read and understand.

_______________________________________________ ____________
SIGNATURE OF PARENT OR LEGAL GUARDIAN ONLY! Date Signed

MEDICAL CONDITIONS OF WHICH TO BE AWARE:

____________________________________________________________________________________
____________________________________________________________________________________
TELEPHONE NUMBER (S) WHERE I MAY BE REACHED IN AN EMERGENCY
____________________________________________________________________________________
I DO NOT WISH FOR MY CHILD TO PARTICIPATE IN THE FOLLOWING:
____________________________________________________________________________________
____________________________________________________________________________________
*DEADLINE FOR PERMISSION SLIPS AND $88 TURNED IN IS: SUNDAY SEPTEMBER 5TH.*
ARRIVE AT CHURCH AT 3:00 P.M. VEHICLE LEAVES CHURCH AT 3:30 P.M.
RETURN TO THE CHURCH APPROXAMTLY 4:00 P.M.