7th & 8th Grade "Our Whole Lives" Information & Registration
DEADLINE FOR REGISTRATION IS FEBRUARY 1, 2019

Friends and guests of our congregation are cordially invited to participate in our ministry. Please feel free to share.

Please thoroughly review the details below and complete the questions and permissions at the end.

**Sponsored by**
First Congregational Church, UCC

**Dates**
1) Participant Orientation & Pizza Party -
- Thursday, February 21st
2) Parent Orientation & Luncheon -
- Sunday, February 10th 11:45 am
3) Retreat -
- Thursday, February 28, 5:30 pm to
- Saturday, March 2nd, 3:00 pm
- (NOTE: no confirmation class the next morning)

**Leaders & Chaperones**
1) Catherine Curtis, Staff (cell phone 630-202-9675) - Chaperone
2) Paula Rada
3) John Pottebaum - Chaperone
4) Tracy Gliori - Leader
5) Tim Landry - Leader
6) Phil Gliori - Leader
7) Gwen Miller - Leader

**Transportation**
Bus rental with professional driver

**Overnight Accommodations**
Marshall Hall
Tower Hill Camp and Retreat Center (http://www.il-outdoorministries.org/assets/tower-hill-brochure-2015.pdf)
12173 Tower Hill Rd
Sawyer, MI 49125
269-426-3881
Photo and layout of Marshall Hall: (http://il-outdoorministries.org/assets/marshall-hall-layout-sheet_w_buttons.pdf)

**Fee**
$160 to $200.00/youth
- We are doing a sliding scale for payment in order to cover the expense of hiring a bus with driver.
If your family is able to pay $200.00, this will assist us with this expense.
- Pay via check made out to "First Congregational Church" w/ Jr Hi OWL on memo line to Catherine Curtis
or by following the link in your confirmation e-mail to pay on-line via credit card
- If this fee is a hardship, please contact Catherine Curtis, to confidentially discuss payment schedules or scholarships.

**Packing List**
1) Sleeping bag and pillow (sheets if preferred)
2) Toiletries/wash cloth/towel(s)
3) Pajamas/sleep clothes
4) Boots (the dining hall is separate from accommodations and we'll be doing some activities outside)
5) Change of clothes appropriate to weather
7) Water bottle with name
8) Winter outer clothes - parka/snow pants (see #4 above)
9) Quiet individual activity if desired, book, mandala
10) Games or cards to share
11) An item that has special meaning to you

**Tentative Schedule (subject to change)**
Thursday
**5:30 - 6:00 pm***Arrive at Church, Check-in & load vehicles
**6:00(CST)-9:00pm (EST)***Departure & Driving
**9:00 - 9:40 pm***Arrive at Tower Hill, Un-load, Set-up

Saturday
**2:00 - 4:00 pm (EST)***Departure & Driving
**3:00 pm (CST) ***Arrive back at FCCGE, assist with unloading of supplies before checking out with a leader

Marshall Hall at Tower Hill Camp
Youth's First Name *
Your answer
Youth's Last Name *
Your answer
E-mail Address where we can send updates & reminders *
Your answer
If your family is a member of another congregation or faith community, please share with us.
Your answer
On which date can your youth attend the Participant Orientation & Pizza Party?
This is a mandatory event as it begins the curriculum and builds the relationships of trust needed between peers and the youth and the leaders.
Youth Information & Permissions
The below information will be kept safely and only distributed to leaders of groups involved. This form allows First Congregational Church, UCC Glen Ellyn vital medical information for our records along with permission for use of photos and communication. To attend this event please fill in the form below by February 13th. Without this information and permission, youth may not attend.
Name(s) of Emergency Contact(s) *
Your answer
Relationship(s) of Emergency Contact(s) *
Your answer
Phone Number(s) of Emergency Contact(s) *
All that apply, such as home, work, cell, other
Your answer
I give permission for my son/daughter to attend *
Please type the name of the parent or guardian completing this information and giving permission.
Your answer
Medical & Health Information
Any Medication should be handed into the main leader and it will be supplied when needed, if the medication needs to be carried by your son/daughter this must be agreed with the organizers. All information will be kept confidential, we cannot accept responsibility for any information not declared.
Please list any allergies (especially food), if none, please indicate "None" *
Include all allergens/foods with severity of reaction, sensitivity (ex. ingestion only) and if the youth will be attending this event with medications.
Your answer
Any special dietary needs? *
If so, please describe in DETAIL, otherwise indicate "None"
Your answer
Do you have any current or on-going medical conditions such as asthma that require medication? *
If none, then indicate "None," otherwise list condition and medication name and dosage information if applicable.
Your answer
Please list any physical limitations or restrictions that may impact the youth's participation in this event, if none, please indicate "None." *
We do not wish to cause someone to feel leftout of activities. Please advise any limitations we should be aware of. We will be sleeping on bunk beds on mattresses indoors. Fun activities may include playing in the snow (if we have some), and a night hike.
Your answer
I give permission for First Congregational Church, UCC Glen Ellyn to publish anonymous photos and/or videos of participant in church publications and on-line social media. *
Is there any additional information that would assist our leaders in providing a safe, welcoming and fun environment and event for the participant? *
Acute fears, begun menstruation, needs a lot sleep, requires physical activity, needs assistance connecting with peers, introverted, etc. ESPECIALLY NOTE IF THERE HAS BEEN A PAST EXPERIENCE, TRAUMA, OR WITNESSED TRAUMA RELATED TO SEXUALITY THAT MAY BE A TRIGGER OR MAKE CERTAIN TOPICS DIFFICULT FOR YOUR YOUTH. If not, please respond "None"
Your answer
Have you registered your family's health insurance information on-line for 2018 - 2019 for church school/youth fellowships? *
Please check the appropriate box. If you have not registered, please visit www.fccge.org and click on "Register Now" to complete the 2018 - 2019 Youth Education Registration which includes a health insurance information request. A photo copy of the front and back of your health insurance card will be required as well.
Church's Policy on Conduct
Our church strives to be a loving place where all feel welcome and safe. We want to truly live into the Apostle Paul's call to be members in the body of Christ, lifting one another up in ways that reflect the love of God. This being said, we understand the incredible pressures that youth feel all the time about what to put in their bodies. When we are on church-related retreats that pressure is removed. Youth do not need to worry about pressure or expectation from others. There will be no use of alcohol, illegal substances, or tobacco products on church trips. There will be no pressure or expectation around sexual activity. We encourage the building of wonderful healthy relationships with others but on church trips we focus on building the entire community. If there is a violation of either of these, the youth involved will be sent home at the parents'/guardians' expense (either by parents coming to get their youth or by other mutually agreed upon arrangements.
Submit
Never submit passwords through Google Forms.
This form was created inside of First Congregational Church of Glen Ellyn. Report Abuse - Terms of Service