Saturday-Sunday, September 12-13, 2015
3:00pm (if paid to play paintball)/5:30pm (no paintball)
$20/$35 (if playing paintball) - non-refundable
Join other Nazarene youth groups at Water’s Edge
Campground. It will be a time of fun and fellowship with
paintball, games, pizza, and worship! Music led
by a worship band from Olivet Nazarene University.
Deadline Wednesday, August 26, 2015
* Parents drop off/pick up at Water’s Edge Campground.
Drop off: Saturday, September 12 @ 3:00pm (if paid to play
paintball), 5:30pm (no paintball).
Pick up: Sunday, September 13 @ Noon.
(Minimum 8 or the event will be cancelled.)
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MORE DETAILS:
WHERE:
Water’s Edge Campground (4171 Woodland Dr., Howell)
WHO:
Students 7th - 12th grade
DROP OFF: Saturday, Sept 12 @ 3:00pm (paintball)/5:30pm (no paintball)
PICK UP:
Sunday, Sept 13 @ Noon
SPONSORING ORGANIZATION: Brighton Nazarene Church,
7669 Brighton Rd., Brighton, MI 48116
TELEPHONE: 810-227-6600 x35
NAME OF STAFF COORDINATOR: Deb Winters & Karla Tobey
*Cost includes: registration, pizza Saturday night, breakfast Sunday
morning, paintball (if included in registration)
*(NOTE: Parents responsible for transportation.)
What To Bring:
 Clothes you can get dirty.
 Sleeping bag, pillow, toiletries.
 Snacks.
YOUR SPOT WILL BE RESERVED ONCE YOU COMPLETE
ALL 4 STEPS BELOW…
1. COMPLETE THE NAZ TWO-SIDED PERMISSION FORM ATTACHED
2. COMPLETE THE EMD PERMISSION FORM ATTACHED
3. $20 CASH/CHECK TO "THE NAZ" (non-refundable)
4. PLACE PERMISSION FORM & CHECK/CASH IN ENVELOPE, DROP
IN THE LOCK BOX IN THE YOUTH CENTER LOBBY BY AUG 26th
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BRIGHTON CHURCH OF THE NAZARENE
PARTICIPANT EMERGENCY AND PERMISSION FORM
Activity: FALL GETAWAY
Date: September 12-13, 2015. Location: Water’s Edge Campground Cost: $20/$35 (non-refundable)
Drop off: Water’s Edge Campground, Sat, Sep 12 @ 3pm if paid for paintball/5:30pm if no paintball
Pick up: Water’s Edge Campground, Sun, Sep 13 @ Noon
Sponsoring Organization: Brighton Nazarene Church, 7669 Brighton Rd., Brighton, MI 48116
Telephone: 810-227-6600x35. Name of Coordinator: Deb Winters & Karla Tobey
By signing below I herby give consent for him/her to participate with the above activity. I agree that I have
read the information given and fully understand that I am responsible for my child’s participation and full
payment. I agree that my child is committing fully to this trip and that should he/she decide to back out, I
am still responsible for the full payment to cover the cost of their spot.
Participant Emergency Information
(To be completed by Participant or an authorized Parent/Guardian)
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Participant's Full Name ________________________________________________________________________________________
D.O.B.________________________________________________________Grade:_________________________ M or F_____________
Participant's Address___________________________City_____________________State______________Zip______________
Participant's Phone (cell) ________________________________(home) ____________________________________________
Participant’s Email __________________________________________________________________________________
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Parent/Guardian Full Name ___________________________________________________________________________________
Parent/Guardian Address ________________________________City _________________State_______Zip_____________
Parent/Guardian Phone (cell) ________________________________(home)_______________________________________
Parent/Guardian E-mail Address_____________________________________________________________________________
Emergency Contact other than Parent/Guardian__________________________________________________________
Emergency Contact Phone #1 ___________________________________ #2__________________________________________
 Is Sponsor Coordinator authorized to approve medical treatment if Parent/Guardian or
Emergency Contact isn't available? _______ Yes _______ No
 Is Participant covered by medical insurance? _______ Yes _______ No
o
If yes, name of insurer ______________________________Policy Number _________________________________
 Please list all known allergies, medical condition or information that we may need to be
aware of:
Participation Agreement
By signing below, the Participant acknowledges and accepts the risks of physical injury with participation in
the activity described above. Except for gross negligence on the part of the Sponsor Coordinator, the
Participant accepts personal financial responsibility for any bodily or personal injury sustained during the
activity. Further, the Participant promises to hold harmless the Brighton Nazarene Church and its
representatives for any injury related to the activity. If a dispute over this agreement or any claim for
damages arises, the Participant agrees to resolve the matter through a mutually acceptable arbitration
process.
 Signature: _____________________________________________________________ Date:____________________________________
(Participant or Parent/Guardian if Participant is a minor)
BRIGHTON CHURCH OF THE NAZARENE
PARTICIPANT COVENANT PROMISE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
I PROMISE TO FOLLOW THE LIST BELOW…
No drugs, alcohol, weapons of any sort (including pocket knives), or fireworks
(including sparklers, party poppers and snap pops).
No sexual activity of any kind.
No PDA (public displays of affection, hand holding, hugging, kissing).
No guys in girls’ rooms and no girls in guys’ rooms.
No guys and girls in the same seat in any vehicle.
Respect others and their property.
Be in rooms by curfew & no sneaking out after curfew, when curfew applies.
Stay in groups of no less than 3.
Check in with chaperones at designated times throughout event or trip.
No gambling of any kind.
When swimming; guys must wear shorts style trunks (no speedos) and girls must wear.
one piece bathing suits. (Tankinis are acceptable as long as they show no midriffs and top is
not low cut.)
Remember that when you are at an activity with the Brighton Nazarene Church, you are
representing the church and you are representing God. You should do so in a way that would be
honorable and glorifying to HIM.
Any rule broken will result in a phone call home made by the student in which the student will
explain the situation to their parent(s). Breaking rules could result in IMMEDIATE dismissal from
the trip. The student will be sent home at his or her own expense. If sent home from any trip, the
student will forfeit their opportunity to attend any future events prior to meeting with the Student
Ministries Pastor.
By signing below, you affirm that you have read and understand all of these Promises. You agree to
abide by these Promises while representing the Brighton Nazarene Church in any capacity. You also
agree to accept any consequence that will be enforced as a result of violation of these Promises.
 Participant's Signature___________________________________________________ Date______________________
 Signature: ________________________________________________________________________ Date:__________________________
(Parent/Guardian if Participant is a minor)
EMD Fall Getaway Sept. 12-13, 2015
Name: ______________________________________________________________ Grade: ______________
Address: __________________________________________________________________________________
City: ___________________________________________
State:_____________
Zip: ________________
Parent/Guardian: ____________________________________________________________________________
Home #: __________________________________
Cell#: _________________________________________
Emergency Contact/phone: ___________________________________________________________________
Do you plan on coming early to play paintball? _________________________ (If yes, please include $15 extra)
Medical Information
Please list all current and approved medications (including medicine such as Tylenol):
_________________________________________________________________________________
_________________________________________________________________________________
Please list any allergies or health information (such as asthma):
_________________________________________________________________________________
_________________________________________________________________________________
Family Doctor ____________________________ Doctor’s Telephone________________________
Insurance Co. _____________________________ Policy No._______________________________
Details:
If playing paintball, plan on arriving at 3:00 and heading
straight to the paintball field.
Registration is from 5:30-6:15 in Bearinger Saturday
There will be a late night snack of pizza and drinks.
The event ends at 12:00 on Sunday.
IMPORTANT!!!
Cost is $20, with paintball
being an extra $15. Please
make checks payable to The
Naz.
night.
I agree to follow the rules of the trip and respect all members and staff working on the trip. I understand that if I
disrespect or misbehave during the trip my parent/guardian will be contacted and I might be asked to leave.
Student Signature: __________________________________________________________________________
I give permission to my son/daughter to participate fully in this trip and I support the rules. Further, should it
be necessary for my son/daughter to return home due to medical reasons, disciplinary action or otherwise, I
herby assume all transportation responsibility.
Parent/Guardian Signature: ___________________________________________________________________