Grace Community Evangelical Free Church Box 720, 160 Seremma Ct., Lake Katrine, ny 12449



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Grace Community Evangelical Free Church

Box 720, 160 Seremma Ct.,

Lake Katrine, NY 12449
As the parent/legal guardian of ___­­­_________________________ ­­­_­________ permission is hereby given

Name of Student Participant

for my child to go on the Grace Community Evangelical Free Church Youth Group Retreat to: Sunshine Acres Camp and Conference Center. 165 Sportsmans Road, Napanoch, NY 12458 (845-647-4230).
I understand and acknowledge that participation in the activities involves inherent risks of injury to my child including risks associated with transportation by motor vehicle.

I give my consent that in my absence the above-named minor may be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named minor.



Date of Birth




Known allergies including any allergies to medicine (Continue on back of form if needed)

Any other medical problems which should be noted (Continue on back of form if needed)

Name of Parent/Guardian

Address




City/State/Zip

Phone Home Work Mobile




Person to notify if parent/guardian is unavailabe


Phone Home Work Mobile


Family Physician Phone

Insurance Carrier & Policy Number







Signature of Parent




Date

Cost for the event is $ 80.00 prior to August 15th. Please make it payable to Grace Community Church.

 Please Check if you would like to request a scholarship





Grace Community Evangelical Free Church

Box 720, 160 Seremma Ct.,

Lake Katrine, NY 12449

Hi Dads and Moms,

I trust that this note finds you well and that you and your family are enjoying the joys of summer. I am writing because the planning for the 2015-2016 OASIS Sr. High Youth Group is in full swing and I want to provide you some information on some up-coming events.

On Friday, August 28th through Sunday, August 30th the OASIS Youth Group will be going on a retreat. This year we will once again be going to Sunshine Acres Camp and Conference Center. This camp is operated by the Young People’s Baptist Union of Brooklyn and Long Island and is located in Napanoch, NY. Enclosed with this letter you will find the permission slip that needs to be completed for your teen(s) to attend this event. More details will be posted on the OASIS page of Grace4ulster.org.

I have also enclosed an invitation letter for your teen to participate in the Inklings Bible Study. I trust it will provide you and your teen the information you need to have to make an informed decision about being a part of this group.

Please take a moment to read the information provided. If you have questions please don’t hesitate to give me a call at 382-2288 (church), or 339-8155 (home) or email me at karenwes86@gmail.com. I am looking forward to the start of OASIS in September and the opportunity to once again minister to all of the students.



In Peace,

Wes Smith
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