Lutheran Valley Retreat July 24-31 2015
Our Savior Lutheran Church
What is the trip about….This summer Sr. High youth get an amazing
opportunity to travel to Colorado to Lutheran Valley Retreat and spend a week getting time to reflect in God’s Word, build relationships with others, and get a chance to serve by working with handicap campers providing them with a camp experience.
The youth will be headed to LVR July 24-31 at LVR. Youth will enjoy a week reflecting on God’s Word through Bible Study and nature, spend time building relationships with Our Savior youth and other youth groups, and serve others with special needs. Youth will also get to enjoy activities offered by LVR such as hiking, rock-climbing, archery, fishing, bouldering, and much more.
This trip is open to youth going into 9th grade fall of ’15 thru high school graduates spring ’15. This is a great
opportunity not only for the youth to serve others but to also grow in their faith and in fellowship with one another.
LVR Schedule *tentative July 24th
8:00amo Depart from Our Savior Lutheran Parking lot
5:00pmo Arrive in Denver, Check into hotel * Something fun in Denver
10:30pm o Devotions
11:00pmo Lights Out
July 25th Water World
July 26th 9:30am
o Church in Denver, CO 12:00pm
o Lunch 1:00pm
o Depart for LVR 4:00pm
o Arrive at LVR
July 26th – 30th LVR Schedule (see next page)
July 31st 6:00am
o Clean/Pack 7:00am
o Depart for Norfolk 10:00pm
o Arrive in Norfolk, NE at Our Savior Lutheran Church
LVR Planning TeamBailey Denker
Cara RieseChristine Ekberg
Haiden SullivanKatie Stapleton
Lori VossMarlie VossRebecca OttenSawyer KuhlTodd Meyer
DEADLINESDeposits:
Registration $50 due February 1st, monthly $50 deposits by the 1st of the month for March, April,
May and June. Remaining balance due July 1st. Total $480
Forms OSL Commitment/Registration due February 1st
LVR Medical & OSL Medical Form due July 1st
Contact Information
LVR P.O. Box 9042Woodland Park, CO 80866Tel: 719-687-3560
Christine [email protected]
402-860-0725
Participants:TBD
A Few Fun Our Savior Guidelines Guidelines
Respect GodRespect OthersRespect Yourself
1. No possession or use of alcohol, drugs, tobacco, or weapons2. No offensive or immodest clothing 3. No boys in girls’ sleeping quarters and no girls in boys’ sleeping quarters4. Participation with the group and comply with event schedules is expected5. Respect for adult leaders (OSL and other adults) is expected6. Cell Phones acceptable in moderation, they WILL NOT work at camp.
Discipline: Scale of discipline dependent on severity of circumstance, warnings will be in given. If a child is subject to be sent home, the decision will be made by youth’s main leader for their church, cost for flight home will be on the family.
What to Bring: (OSL guidelines)T-shirts/Tank tops (Tanks – 1 ½inch straps) Shorts or Pants (shorts at least a 4 inch inseam) Alarm clock (watch, you can’t use your phone)
Lutheran Valley RetreatSummer CampThings To Bring
Bible & Pencil or Pen Towel & Washcloth Sleeping Bag or Bedding (At least 40 degree) Soap & Shampoo Pillow Toothbrush & Toothpaste Clothing for Sleeping Comb or Brush Pants Shower Sandals Shorts (at least 1 per day)
Chapstick & Sun Screen
Sturdy Shoes (at least 1 pair will get dirty) Shirts (at least 1 per day)
Day Pack Hat or Cap
Things NOT To Bring
MP 3 players/I-pods, Knives, Fire Works, Curling Irons, or Blow DryersGum, Sling Shots, Cell Phones (they don’t work @ LVR anyway).
The Camp StoreWhile at Lutheran Valley Retreat you will have the opportunity to use the Camp Store. At the
Camp Store you will be able to purchase snacks and drinks at $.75 each. There are also Shirts, Sweatshirts, Hats, Bandanas, Water Bottles, and much, much more. Items are priced from $3 up
to $40.
LUTHERAN VALLEY RETREAT CONTACT AND HEALTH HISTORY FORM
Dates of Camp Session ________________
Name _______________________________________ Birthdate _______________ Circle M/F
Address _________________________ ____________ City/State/Zip ________________________________
Parent Name __________________________________ Home Phone Number _________________________
Place of Employment ___________________________ Work Phone _________________________________
E-Mail _______________________________________ Cell Phone __________________________________
Parent Name __________________________________ Home Phone Number _________________________
Place of Employment ___________________________ Work Phone _________________________________
E-Mail _______________________________________ Cell Phone __________________________________
Emergency Contact Name _______________________ Relationship to Camper _______________________
Emergency Contact Address ______________________ Emergency Contact Phone _____________________
Family Medical Insurance Company ______________ Insurance Phone ____________________________
Insurance Address______________________________ Insurance City/State/Zip______________________
Parent Permission & EndorsementThis health history is correct so far as I know & the child herein descried has permission to engage in all prescribed activities including, without limitation, climbing/rappelling, equine, low and high ropes courses, rafting, and walking or riding in camp vehicles, except ________________________________________.I understand that many of these activities are limited to 11 year and older youth. I hereby assume the risk of all injuries to the person herein described & I release and discharge Lutheran Valley Retreat, its agents and employees from any and all liability that results from injury to the person herein described. Insurance protection is my responsibility. I give permission for the camp to administer medications as it deems necessary to this child, including medications sent with my child or nonprescription medications available at camp. In the case of an emergency, I know every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission for the medic selected by the camp director to hospitalize and secure proper treatment for my child. I assume financial responsibility for actions that may cause damage to property.If the staff deems it necessary for my child to be removed from camp, due to disciplinary or other problems I will respond by promptly picking up my child from camp.
Signature of Parent/Guardian _____________________________ Date______________________
Dates of Camp Session ________________Camper Name__________________________Lutheran Valley Retreat requires every camper to have a physical within 12 months prior to their camp session; doctor may sign a photocopy of this form, but all signatures must be original and include camper's name.
Height: ________________ Weight:_________________ Blood Pressure: __________________
Current Medication: Please not, all prescription MUST be prescribed to this individual, within expiration date, and in their original packaging
Name of Medication Reason for taking Dosage Schedule
Health History
Condition Circle one If Yes: Condition Circle
one If Yes: Condition Circle one If Yes: Condition Circle
one If Yes: Conditions Circle one If Yes:
Anxiety or depression
No
Yes
Current
PastRecurrent Headaches
No
Yes
Current
Past
Heart Disease or problems
No
Yes
Current
PastDiabetes
No
Yes
Current
Past
ADD or
ADHD
No
Yes
Current
Past
EpilepsyNo
Yes
Current
PastAsthma
No
Yes
Current
PastFrequent
ColdsNo
Yes
Current
Past
Frequent Ear
Infections
No
Yes
Current
PastBed
WettingNo
Yes
Current
Past
Ear, Nose, or Throat Trouble
No
Yes
Current
Past
Disease or injury to joints or
back
No
YesCurrent
Past
Stomach or intestine
trouble
No
Yes
Current
Past
Dizzy Spells or Fainting
No
Yes
Current
PastHome
SicknessNo
Yes
Current
Past
Eating Disorders
No
Yes
Current
Past
Comments, other issues, physical limitations and/or list surgeris
Allergies/Dietary Needs
Type of Allergy Circle Describe/Specify Allergen Mild
(runny nose, sneezing)
Moderate
(Swelling or severe rash)
Severe
(System Response/Difficulty breathing)
Food No Yes
Medication No Yes
Environmental (animal, insect, etc.) No Yes
Other No Yes
Vegetarian? No Yes Limitations: Gluten Allergy? No Yes Limitations: Lactose Intolerant? No Yes Limitations:
Immunizations
Vaccination Most Recent Date
Vaccination Most Recent Date
Vaccination
Most Recent Date Vaccination Most Recent Date
Vaccination Most Recent Date
Measles, Mumps, Rubella (MMR)
Hepatitis A HIB Chicken Pox (or had the disease)
Influenza
Diptheria/Tetanus (DPT)
Hepatitis B Polio Other Other
I have examined and found camper to be in satisfactory physical condition, free from any contagious desease and capable of active participation in a regular camp program at altitudes of 8,400-9,100 feet above seal level except as follows____________________________
The camper is under the care of a physician for the following condition(s):_____________________________________________________
Licensed Phsician's Signature________________________ Date of Examination___________________________________________
Doctor Name___________________________________ Doctor Phone __________________________________________________Doctor Address_______________________________________________________________________________________________
Doctor City/State/Zip__________________________________________________________________________________________Official Use only (camp staff only to be determined on site): The camper appears to be healthy and free of contagious desease and capable of active participation for all camp activities. Circle one Yes No
OUR SAVIOR COMMITMENT FORM LVR 2015
Motivated by God’s love for me, I, __________________________________, commit to exploring, sharing, and growing in my faith this year. As a part of the Our Savior Lutheran Youth Group I plan to attend the summer servant event to Lutheran Valley Retreat, Woodland Park, Colorado.
Parent YouthInitials Initials
_____ _____ I understand the spiritual, financial, and personal conduct expectations that are a part of this trip. I also understand this deposit is non-refundable. If an unavoidable circumstance causes me to not attend the trip, I know that I will not be refunded any payments made toward the trip and will not be held responsible for any remaining payments.
_____ _____ Throughout this experience we will be intentional about sharing God’s love with others through both our actions and our words. I will build relationships with fellow youth, serve my peers, and strengthen our youth group by being actively involved in worship and Senior High Youth Group and/or Formula 3:18 before and after the trip. (Minimum of 7 youth Bible Studies between now and the trip.)
_____ _____ It is the work of many people to coordinate and prepare for the this trip. I will do my part by attending the required bible studies and training prior to the trip scheduled for TBA April or May.
With my signature affixed below, I hereby give permission for my child, ______________________________, to attend Lutheran Valley Retreat summer trip. This signed agreement hereby absolves the volunteer sponsors, Our Savior, the church staff, and any and all members of its governing boards of any responsibility for the safety, welfare, health, and well-being for the above mentioned child beyond such matters as may be called reasonable care for youth in the care of a sponsor, and subject to the sponsor’s clear instructions. The undersigned also assumes, personally and exclusively, all responsibility and liability for accident, injury, or other misfortune which may occur to the above-named child during the time of this activity.
My child agrees to behave responsibly according to the laws of the State, the rules of Our Savior Lutheran Church and the reasonable expectations of the adult sponsors.
I also affirm that my child has the following items up to date and on file at Our Savior Lutheran Church: Emergency Medical Release From
$50 deposit due at registration (February 1st).$50 monthly deposits due the 1st of Mar, Apr, May, Jun and remaining balance due July1. Total $480
_____________________________________________ __________________________Youth Signature Date
_____________________________________________ __________________________Parent Signature Date