Reconnection Retreat
Wellesley Hills Congregational Church
Sunday, October 4th
Permission Slip
ALL YOUTH in grades 7 thru 12 are invited to join us for a day of worship and fun together.
We will start in the Assembly Room at 9 am, for breakfast together. Then we will sit together for worship. Bring a bag lunch; we will eat and share our thoughts on the sermon and the service.
Dress for play because around noon we will load up some vehicles in order to travel to the Mega Maze at Davis Farmland. There we will zipline, explore the maze, attempt an obstacle course and more. Bring your own water bottle. We will return to the church for pick up at 5:00 pm.
Student Name:______Grade:______
I give permission for my child to attend the WHCC events referenced above. I acknowledge they will be traveling to and from Davis Farmland in Sterling, MA. In the event of emergency, I authorize the minister or adult attendees to direct any and all medical procedures, including anesthesia, as such needs arise during the time my child is in your care. I understand all reasonable precautions will be observed in the supervision of activities, but beyond that I do not hold WHCC, its minister, or adult attendees responsible. I also understand that if a discipline problem arises, I will need to pick up my child and return him/her home upon request.
Signed:______(parent/guardian) Date:______
Phone #(s) where parent/s can be reached during trip: (home)______(First Cell) ______Whose ______
(Second Cell) ______Whose______
If necessary, other emergency contact(s) during trip: (name & phone)
______
Health Insurance Policy Info: Please include a photo copy of both sides of their insurance card
*Medications taken regularly by student:
______
*Allergies:______
Other pertinent health information:
______
*Medications (both OTC and prescription) and instructions will be held by an adult, unless other arrangements are made. Please have medications in their original containers with information and dosage.
Registration Forms and Money [$25 per student] are due to
Kate Rogers or Jessica Boose by September 27th, 2015
Checks should be made out to W.H.C.C. and mailed to
207 Washington St., Wellesley, MA, 02481