2019 CYF Midwinter Retreat - "Snow-One is Perfect"
WHEN: Friday, January 4th at 7:00pm - Sunday, January 6th at 11:00am

WHERE: Tall Oaks Conference Center

WHO: 9th-12th graders

COST: $130 ($145 after Dec 21st, 2018). NO ONLINE REGISTRATIONS ACCEPTED AFTER: DECEMBER 28th

THEME: Snow-One is Perfect

KEYNOTER: Rev. Dr. Delesslyn Kennebrew, Regional Minister for New & Transforming Churches!!!


*** Please Register for Midwinter on this form and then mail your Payment made out to the Greater KC Region with the participant's name written in the memo line along with "CYF Midwinter":

Mail to:

Rev. Lara Blackwood Pickrel
201 N Bridge Street
Smithville, MO 64089

** No adult sponsors are needed. Counselors have been recruited for this event.
Questions? Contact: Rev. Lara Blackwood Pickrel at lara@smithvillefcc.org

Email address *
First Name of attendee *
Your answer
Last Name *
Your answer
Gender *
Grade *
Church Congregation
Your answer
Youth email
Your answer
Home Address *
Your answer
Parent/Guardian #1 Name *
Your answer
Parent/Guardian #1 Phone number *
Your answer
Parent Email *
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 Phone number
Your answer
Physician's Name & Telephone number *
Your answer
Insurance Carrier & insurance Telephone number
Your answer
Insurance Policy number
Your answer
Please list any medical conditions/medications that a physician should know before treatment.
Your answer
List and describe any Food Allergies or special Dietary Needs(including severity of allergy)
Your answer
Is there anything else you would like the directors to be aware of?
Your answer
CYF MIDWINTER RETREAT PERMISSION/YOUTH COVENANT
IF UNDER 18 YEARS OF AGE, YOUTH MUST HAVE PARENT PERMISSION TO ATTEND.
Parental/Guardian Consent

This youth has my permission to participate in the CYF Midwinter Retreat of the Greater Kansas City Region, Christian Church (Disciples of Christ). I will not hold the GKC Region, Tall Oaks conference center, the ministers, or the adult leaders responsible for liability in injuries, or accidents that might occur during this event and by this document do release them from any liability. I authorize any of the ministers or youth leaders to take my child to a licensed physician or hospital for any emergency, medical aid, or hospitalization required during the event. I also request that the ministers/leaders make a reasonable attempt to contact me in the event of such an accident. I understand that rules and regulations will be established governing participation as part of any sponsored group, and conduct during the event. I have instructed my child that she or he must abide by those rules. I also give consent for my child to be appropriately photographed within the context of the event to be used in website, print, and other promotion of this Regional Youth Event as well as other events in the future.
Parent Signature *
Your answer
Youth Covenant

I agree to follow all rules set out by Tall Oaks Staff, adult leaders, and other event staff. I realize that if I bring prohibited items (including: tobacco, alcohol, illegal drugs, prescription drugs that have not been prescribed to me, weapons of any kind, fireworks, etc.), my parents/guardians will be called and I will be sent home from Midwinter immediately. I also realize that negative behaviors like bullying will not be tolerated and may lead to me being sent home. I agree to come to this event with an open heart, ready to participate in all games, small groups, lessons, and other activities – and I agree to have fun!
Youth Signature *
Your answer
A copy of your responses will be emailed to the address you provided.
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