roswell student ministries

Second Mile Middle School Mission Camp

June 23-27, 2013

$190 Total Cost

Total amount due with registration by June 9th!.

For more information on this trip, click here.

This trip is open to students going into Grades 6-7. We will only accept COMPLETED APPLICATIONS along with full payment. If you have any questions, please contact Jill in the Student Ministry Office @ (770) 261-1776 or jcosgrove@rumc.com.

 I) Student Information

 Male       Female

Name        D.O.B.      Age     

Address       

City      State      Zip 

Grade     School  

  Member of RUMC           Visitor           Guest of:

Tshirt Size    (adult sizes)    Small       Medium     Large      X-large      XX-large

II) Roswell Student Ministry Trip Rules

1) No alcohol or tobacco in any form is ever permitted on youth trips.                                                                                    

2) You will be respectful to your adult volunteers and Student Ministry staff.                                                                            

3) You are never to go anywhere alone.                                                                                                                              

4) Remember You are representing Roswell United Methodist Church at all times.  

5) You are to conduct yourself as a Chrstian by your words and your deeds at all times.                                                        

6) No profanity.                                                                                                                                                                 

7) No fireworks, weapons, lighters or matches are allowed.                                                                                                  

8) No guys and girls should ever be alone together.                                                                                                             

9) If you are in question whether or not something is allowed please ask an adult.

I have read and understand all of the Roswell Student Minsitry trip rules. By checking the box below I agree to follow each of these rules. If I break a rule I understand that I can be sent home, at my parent's expense, as a result.

 I agree      Name     Date 

III) Trip Costs

The total cost for Second Mile Middle School Mission Camp is $190 and includes all expenses such as food, lodging, transportation from the Dod to all activities, and all mission expenses. Deadline for resgitration is June 9th. Please use the button below to pay with PayPal or send a check payable to Roswell United Methodist Church (or RUMC) to: Student Minsitry c/o RUMC, 814 Mimosa Blvd, Roswell, GA, 30075. Limited scholarships are available. Refund Policy: Full refund available up to 30 days before trip departure. No refunds after that time. Fees are possibly transferrable. Any questions? PLease email Jason Scott at scottj@rumc,com or Jill Cosgrove at jcosgrove@rumc.com.

IV) Legal Stuff

For Parents:

If there are any existing medical limitations, including allergies, which would affect or limit your child's activity, or of which medical personnel should be made aware, please indicate below. Medical conditions, current prescriptions/regular medications, and/or special instructions are:

Roswell United Methodist Church, inlcuding employees and representatives shall be held harmless from any suit, action, damages, or claims at law or otherwise, resulting from oor arising out of any injury, accident, or illness which may befall    (Name os student)  and/or his/her property while a participant in this event.

By checking the box below, the parent or guardian hereby authorizes Roswell United Methodist CHurch representatives to take such action as may be necessary for the medical care or treatment including the administration of medication, performing of surgery, or other such action as needed in the event of injury or illness of participant when parent/guardian cannot be reached for authorization. This authorization may be presented to medical personnel without liability of said personnel to seek further authority.

In the event of a medical emergency the Roswell Student Ministries team will make every effort to contact a parent/guardian before seeking medical treatment. If we are unable to reach a parent we will excercise good judgment and seek medical treatment as needed. Roswell UMC will pay for the medical treatment and the parent/guardian will be responsible for the entire bill.

 I agree             Parent/Guardian     Date 

Please give us the names of two people that we may contact in the event of an emergency during the trip:

Name      Relationship to Student 

Phone 1     Phone 2 

Name      Relationship to Student 

Phone 1     Phone 2 

Roswell Student Ministry staff and adult volunteers will not be responsible for items that are lost, damaged, or stolen during the course of this retreat. Students will be responsible for their personal items such as wallets, ipods, phones, etc.

I have read and understand the above statement:     (Students Initials)

Disclaimer: I understand that my photograph may be taken while on this trip and posted on the RUMC or Roswell STudent Ministry websites or the RUMC or Roswell Student Ministry Facebook pages.

  I understand and allow             I understand and do not allow