Retreat Reservation Packet

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1 Retreat Reservation Packet 1050 Road 4 Schuyler, NE Phone: Fax: Visit us Online at:

2 RETREAT REGISTRATION FORM GROUP NAME: DATES OF EVENT: ARRIVAL TIME: DEPARTURE TIME: CONTACT S NAME: CONTACT S ADDRESS: ADDRESS: WORK PHONE: PERSONAL/CELL PHONE: FAX: RATE WORKSHEET Overnight Use: Gerwick $22.00/person Cabins: $22.00/person Barn: $22.00/person Male= Female= = Chaperones (1/2 price): Male= Female= = Meal Charges: $6.00/person/meal (use table below) = Evening Snack: $3.00/person (use table below) = TOTAL COST = PLEASE NOTE: A $100 deposit is required in order to hold your date. Deposit is non-refundable and non-transferable. MEAL SERVICE WORKSHEET Please mark any meals you would like Camp Luther to prepare. If you would like to prepare your own meals, there is a $10.00 Kitchenette usage fee for each day. Mon. Tues. Wed. Thurs. Fri. Sat. Sun. Breakfast Lunch Supper Snack RETURN FORM TO: Camp Luther of Nebraska, Inc Road 4 Schuyler, NE Phone: Fax:

3 SUPERVISION: *THINGS TO KNOW BEFORE YOU MAKE YOUR RESERVATION* CAMPER/ADULT SUPERVISION SHOULD BE A MINIMUM OF 10/1 AT ALL TIMES. CAMPERS UNDER 18 SHOULD NOT BE WITHOUT ADULT SUPERVISION AT ANY TIME. ALL MEALS SHOULD BE SUPERVISED BY ADULTS. ADULTS MUST SUPERVISE ALL CAMPFIRES. RULES: SHOW RESPECT FOR YOUR LEADERS, CAMP STAFF, OTHERS, YOURSELF, CAMP PROPERTY AND TO GOD AND HIS CREATION. NO FOOD OR DRINK ALLOWED IN SLEEPING AREAS. NO THROWING OF THINGS IN GERWICK HALL. USE ONLY BUILDINGS YOUR GROUP HAS PERMISSION TO USE. EXTINGUISH ALL CAMPFIRES BEFORE LEAVING THE AREA. PETS ARE NOT ALLOWED ON CAMP GROUNDS OR IN BUILDINGS. NO SMOKING ON CAMP PROPERTY INCLUDING ALL BUILDINGS. FOLLOW RULES THAT ARE POSTED FOR SWIMMING AREA, WATER SLIDE, BOATING AND ARCHERY. AFTER COMPLETING AND SIGNING THIS FORM, MAKE A COPY FOR YOURSELF AND RETURN ORIGINAL TO CAMP LUTHER ALONG WITH YOUR DEPOSIT. REMEMBER: A $100 DEPOSIT IS REQUIRED IN ORDER TO HOLD YOUR DATE. DEPOSITS WILL NOT VE REFUNDED OR TRANSFERRED. YOU WILL BE CONTACTED BY THE CAMP TO MAKE FINAL ARRANGEMENTS AFTER THIS FORM AND YOUR DEPOSIT HAVE BEEN RECEIVED. Having read and fully understanding the items on this agreement and both sides of the attached letter, I, as the authorized representative of the group and event, agree to them. I accept responsibility of communicating the information on these sheets to our group and will see that the rules are observed. SIGNATURE: DATE: If you have questions feel free to , write, fax or call us. May God bless you as you plan. We will do all we can to glorify God with you through your event.

4 THINGS TO KNOW BEFORE YOU COME: CAMPER/ADULT RATIO: A 10/1 ratio should be in effect at all times. At least one adult must be in each sleeping area. If you have male and female students you will need male and female adults. SCHEDULE/PROGRAMMING: After your registration form and deposit have been received you will be contacted regarding your schedule and programming you want the Camp Luther staff to lead. You will also be able to indicate other activities you d like included in your schedule. EQUIPMENT NEEDS: Once your registration form and deposit have been received you will receive a list of available equipment and services. You can then request what you would like us to have ready for your group. EXCLUSIVE USE OF CAMP LUTHER: Exclusive use of the camp is available for your use for an extra fee. Otherwise there may be multiple groups on site. Submitting your schedule well in advance will help us coordinate the use of equipment, facilities and staff. WHAT TO BRING: Each person must bring his/her own sleeping bags, bedding, towels, etc. A complete WHAT TO BRING list is included at the end of this form that you can copy and distribute to your campers if you d like. HEALTH HISTORY AND EMERGENCY FORM: You may use your school or church s health form, or have parents fill out the form from Camp Luther. You must have a form for each student, but these stay with the leader or sponsor of the group, we will not collect these. RECYCLING: Camp Luther recycles soda cans, plastic bottles, cardboard, etc. Please place these items in the appropriate marked container. Please ask if you re not sure. Thanks THINGS TO KNOW WHILE YOU ARE HERE ARRIVAL: Upon arrival please go to Gerwick Hall where you will be met by a member of the Camp Luther staff. Please drive slowly through the camp so everyone can watch for deer and wild turkey. Once you ve been instructed to unload please refrain from vehicle use until you are ready to leave. This helps ensure a peaceful and safe atmosphere. RULES: Upon arrival a camp staffer will greet your group and speak with them about the camp rules. Before you come please share the rules with your campers that are outlined on the registration sheet. At all times please SHOW RESPECT FOR YOUR LEADERS, OTHERS, YOURSELF, THE CAMP PROPERTY AND GOD. FREE TIME: Youth under 18 should be under adult supervision at all times. This helps keep them safe, provides time for the adults to be mentoring role models, and prevents damage to the camp. A successful way to offer free time is to designate 3-4 areas that campers can chose from, and then have adults stationed at each area.

5 MEALS: If we provide your meal service you may expect the following unless changes are requested. + You may set up the tables as you wish if you are the only group eating. + Meal prayer songs will be led by our staff. + Seconds are usually available. + Directions will be given regarding serving, clean-up, etc. + Your group will be asked to take turns wiping tables, sweeping, etc. + Everyone should remain at their seat until after the closing prayer. + Meals will be served at 8AM, NOON, and 6PM. SNACKS: Do not store or consume food, candy or drinks in the sleeping areas. Insects and mice with their keen sense of smell will quickly find it even if there are only empty wrappers. In the dining area it is helpful to clean up any food messes or crumbs before nightfall. If you bring snacks be sure to put them away each night. You may also choose to have our food service provide snacks for an extra fee. KITCHEN USE: The camp s commercial kitchen is not available to groups to use or enter. (State Health Regulations) A kitchenette in Gerwick Hall with a refrigerator, stove, microwave, sinks, etc. is available for your use for an extra fee. ($10 per day) THINGS TO KNOW BEFORE YOU LEAVE CLEAN-UP: Pick up any litter, sweep floors of sleeping area and dining area, put chairs and tables on racks, return all furniture, bunks, etc. to their original location. Please assign one adult group member to check the building(s) after everyone else is out to turn out lights, fans and space heaters, close all doors and windows and take along any items left behind. PAYMENT: Full payment of all fees is required within two weeks after your group s event. Should there be any malicious or careless damages to Camp Luther s property, facilities or equipment by event participants your group is financially responsible. WE ARE LOOKING FORWARD TO SERVING YOU AND MAKING YOUR STAY AT CAMP LUTHER THE BEST IT CAN BE. TO GOD ALONE BE THE GLORY.

6 What to Bring to Camp Luther: Your Bible Pens or pencils Pillow Sleeping bag (Sheet or light blanket if desired) Towels and washcloths Soap, shampoo, comb, brush, deodorant, etc. Toothbrush and Toothpaste Sunscreen 2 pair long pants 2 pair of shoes that can be used for running and hiking Flip flops for shower Rain gear Clothes for warm, cool or wet weather (shirts, shorts, jackets, rain ponchos, etc.) Socks, underwear and pajamas Flashlight with fresh batteries Hat Water bottle* Insect repellent* (optional) Camera and film* (optional) *These items are sold at the camp store for your convenience. Please Do Not Bring: Medicine (give all medications to your group leader to keep and distribute as needed) Gum, Food or drinks unless your teacher tells you to Electronic/entertainment devices (CD players, cell phones, games, radios, ipods, etc.) Inappropriate clothing Magazines Knives or any dangerous item Anything that detracts from the natural, outdoor, Christian experience

7 HEALTH HISTORY & EMERGENCY FORM Name: Date and Camp/Event: Emergency Contact: Relationship: Home Phone: Cell/Work: Secondary Contact: Relationship: Home Phone: Cell/Work: Name of Physician: Phone: Dentist/Orthodontist: Phone: Health Insurance Carrier (or attach card): Address: Policy #: Phone: Known Medical Conditions: (If camper is prone to headaches, injury, etc. please send appropriate medication with instructions.) Please list any current medications and why being taken: (Must be in original container, these will be collected and distributed per instructions.) Are there any dietary restrictions we need to know about? Up to date on immunizations? Yes: No: Date of last tetanus shot: This health history is correct and accurate as far as I know, and the person described herein has permission to engage in all prescribed camp activities except as noted. I hereby give permission to the medical personnel selected by the camp director to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for this person. In the event I cannot be reached in an emergency, I hereby give my permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named. I allow this person s picture/video to be taken for use in promotion and publicity efforts of Camp Luther of Nebraska, Inc. unless this statement is crossed out. Signature of parent or Guardian (or self if over 18) X Date:

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