Name: Erieside Youth Stony Glen Campout
Start: 2023-09-15T18:00:00+00:00
End: 2023-09-17T13:00:00+00:00
Location: Stony Glen Camp

COST: $45 per camper (for teens in grades 7-12)

(‘Family Rate’ of $75 for 2 Students or $100 for 3 Students available!)

WHEN: 6:00 pm Friday, September 15th ~ 1:00 pm Sunday, September 17th

WHERE: Stony Glen Camp, 5300 West Loveland Rd., Madison OH 44057

PICK-UP/DROP-OFF: Parents will be responsible for the transportation of their child/children to & from Stony Glen. Drop-off is between 6-7 pm on Friday, September 15th. Pick-up on Sunday, September 17th at 1 pm (after Church service at Erieside).

DEADLINE TO REGISTER ~ SUN, September 10th (both registration & payment must be received in the church office by this date). DON’T DELAY – SPACE IS LIMITED in the boys/girls cabins!

Also, please note that STUDENTS MUST ATTEND ONE WEDNESDAY BIBLE STUDY OR SUNDAY MORNING SERVICE prior to Stony Glen to be eligible for attendance on the weekend.

WHAT TO BRING: Please keep in mind that we will be hiking & adventuring outdoors, and that campers will likely get wet! Pack weather-appropriate clothing (at least 2-3 outfits for Saturday-Sunday). Campers should bring an extra pair of boots/shoes, extra socks, sleeping bag, blanket, pillow & flashlight. All campers need to bring their Bibles & a notebook (Phones will not be used as Bibles)! Bottled water will be provided.

WHAT NOT TO BRING: Campers are NOT permitted to bring IPods, IPads, Tablets, MP3 players, or electronic games (Cell Phones may be left in Student’s bag but are not for use during the weekend!)

Youth Stony Glen Weekend 2023

How Many Students will be joining us?*
Please enter a number from 1 to 3.
CAMPER 1 Info:
Camper #1 Name*
First Last
Gender*
- Male
- Female
Date of Birth (MM/DD/YYYY)*
Grade in School*
Allergies & Medical/Chronic Issues (if any)
Current Medications (if any)
Last Tetanus Immunization
Month
Day
Year
Camper 2 Info:
Child #2 Name
First Last
Gender
- Male
- Female
Date of Birth (MM/DD/YYYY)
Grade in School
Allergies & Medical/Chronic Issues (if any)
Current Medications (if any)
Last Tetanus Immunization
Month
Day
Year
Camper 3 Info:
Child #3 Name
First Last
Gender
- Male
- Female
Date of Birth (MM/DD/YYYY)
Grade in School
Allergies & Medical/Chronic Issues (if any)
Current Medications (if any)
Last Tetanus Immunization
Month
Day
Year
PARENT/LEGAL GUARDIAN
Name of Parent(s)/Legal Guardian:*
Address:*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian's Phone #*
Email Address*
Emergency Contact (other than Parent/Guardian)*
Emergency Contact's Phone #:*
Relationship to Child*
People Authorized to Pick-Up Your Child (if you cannot):*

Do NOT leave blank ~ write "NONE" if there is to be no one else.
INSURANCE INFORMATION
Insurance Company/Provider
Subscriber Name (Main Policy Holder)
Subscriber #
Group #
Other Comments & Information
Medical and Release of Liability Form*
YES
I hereby authorize any of the Erieside Church youth ministry leaders to consent to any medical treatment and hospital care which is deemed advisable and is to be rendered under the general or specific supervision of any licensed physician or surgeon. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power to the Erieside Church youth ministry leaders and volunteers to give specific consent for such diagnosis, treatment, or hospital care which the physician, in the exercise of his best judgment, may deem advisable.
Photography Consent
YES
I grant Erieside Church and/or the Youth Group Leaders permission to photograph the minor(s) designated above in any manner for any lawful purpose associated with the Erieside Youth Camp Out at Stony Glen on September 16th-18th.
Electronic Signature (type your full name in space below):*

I agree that my electronic signature is the legally binding equivalent to my handwritten signature, and has the same validity and meaning as my handwritten signature.

Erieside Youth Stony Glen Campout

September 15 @ 6:00 pm - September 17 @ 1:00 pm

Youth Stony Glen Weekend 2023

CAMPER 1 Info:

Camper 2 Info:

Camper 3 Info:

PARENT/LEGAL GUARDIAN

INSURANCE INFORMATION

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Details

Venue

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