Greenville Young LifeWeekend Camp at
Carolina Point

January 29-31, 2016

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Yes, I want to go! Sign me up for Carolina Point!
Name ______Gender______
School ______Grade ______T shirt Size ______
Parents or Guardians ______Parent email ______
Address ______
City ______Zip ______Parent Phone (h) ______(cell) ______
I need the late bus! ______(Players and Cheerleaders only)

Parental Consent for Medical Treatment
In the event the your child becomes ill or injured while attending Young Life’s Carolina Point winter retreat, we request that Young Life be given permission to take your child to the nearest medical facility or healthcare provider and have the necessary treatment administered. Your signature verifies your child is in good health and capable of participating in strenuous activities. Your signature will also acknowledge your acceptance and understanding of Young Life’s role in the medical treatment of your child. In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give Young Life the permission to act in my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary by Young Life. I hereby give permission to the medical personnel selected by Young Life to order x-rays, routine tests, treatment; maintain and/or releases any medical records necessary for insurance purposes as outlined under the hipaa regulations. *I absolve Young Life from liability in acting on my behalf in this regard. * Young Life is compliant with Health Insurance Portability and Accountability Act (or HIPAA) To obtain a copy of Young Life’s Notice of Privacy Practice, log onto or call 719-381-1950. I hereby grant Young Life the right to use, reproduce, distribute photographs, films, video tapes and sound recording of my child without compensation or approval rights.

*Parent’s Signature ______
Emer. Contact Name ______Emer. Contact Phone ______
Parent’s Insurance Co______Insurance Policy Number ______
Insurance Address ______

Further Information:

Carolina Point: Carolina Point is Young Life’s newest camp! Young Life camping involves high adventure, great food, a quantum leap, mountain bikes, bubble soccer, and four wild Young Life clubs!!

Travel/Transportation: We will be departing at 4:00 pm from the Big Lots/Bi-Lo parking lotat the corner of N Pleasantburg Dr and Rutherford Rd on Friday, Jan. 29 and returning at 3:00pm on Sunday, Jan. 31. We will travel via professionally driven charter buses. If your child is a varsity basketball player or cheerleader, there will be a late-bus option for him or her.

Fee: Camp fee includes: transportation, insurance, lodging, meals at camp, and all activities at camp. We are committed to not let money be a reason not to go to camp, please communicate with us early if this is an obstacle.

What to Bring: Sleeping bag, pillow, towel, clothes to get messy, WARM clothes, shoes that can get muddy/wet, swimsuit (if you’re daring), toiletries, spending money for snack bar and camp store.

When: Friday, January 29– Sunday, January 31, 2016
Where: CAROLINA POINT, Young Life’s newest camp!
Who: Eastside, Mauldin, Wade Hampton and Travelers Rest High School
How much: $167 ($67 deposit is non-refundable)

How to register:
Complete the registration form on the front, attach a check for $167 ($67 deposit is non-refundable) made out to “Young Life” (with your child’s name and school in the memo line), and turn both in to a Young Life leader or mail your money and form to our office at:
Greenville Young Life
2320 E North Street, Suite N
Greenville, SC 29607
For more information, please visit our website: greenvillesc.younglife.org
(864) 271-4396