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January 7-9 2011

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Register by Dec. 8th for

Ghormley

Christian
9-12 graders
a

Meadow
e

the lowest price!

FUSE

Camp
t
Retr
W in
Returning to Cascade Sunday at 4PM
Important Information!

Personal electronic musical devices

Meet at Cascade Friday at 3PM

1 Set of clothes that clash

What not to bring!

Firearms, knives, fireworks

Tobacco, drugs or alcohol

What to bring!
Emergency Number:

Camera (optional)

Cascade Community Church

Winter Clothes

Electronic games
Warm Clothes

14377 Fryelands Blvd.

Sr High Youth Ministry
Sleeping Bag

Monroe, WA 98272
2 way radios
Flashlight

Cell phones
Toiletries

360.794.4600
Pillow
Bible

authorization and consent for treatment of a minor and release from liability
I, the undersigned parent (legal guardian) of ___________________________, a minor, understand that in the event medical treatment is required, every effort
will be made to contact me. However, if I cannot be reached, I do hereby authorize Cascade Community Church as an agent for the undersigned to consent to
an x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to rendered under the
general or special supervision of any physician or surgeon licensed under the provisions of the PHYSICIANS AND SURGEONS ACT and on the medical staff of
a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or said hospital.
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 on the part of our aforesaid agent, to give specific consent to nay and all such diagnosis, treatment or hospital care which aforesaid physician in the
exercise of his best judgement many deem advisable.
I have read the above and consent to my child in participating in the activities of the event. I also understand that my child is under the authority of the church
leadership and that failure to comply with leadership could result in dismissing my child from this event and my being called to pick him/her up.
Does student have any allergies or medication needs? If so, please indicate__________________________________. Insurance policy
#______________________________
Parent or Guardian Signature _______________________________________________ Date_____________________________
 et rea t
nt er R Registration
W i
FUSE
Name:

2011
Grade: Age: Birthdate:

us
Parents Names:

t h Jes
t er s wi Address:

Encoun
Fuse will be heading to Ghormley for Phone:

our winter retreat.

Emergency Name and Contact number:

This is a weekend for students to get

away to connect with God...
connect with one another...
cost
& have lots of fun in the snow! $90 if paid by December 8th
$100 after December 8th
tubing Registration Deadline is
December 19th
group games Make checks payable to
Cascade Community Church

winter activities For scholarship information, please

stop by the church or visit the
Ghormley Meadow Christian camp is located at 640 Lost Lake Rd. Naches, WA 98937
church website
Phone: 509.672.4311 www.ghormleymeadow.org
for an application no later than
December 5th