Winter Retreat 2013

When: Where: Cost:

Friday, January 25 to Sunday, January 27, 2013 Redwood Glen; 100 Wright Drive, Loma Mar, CA 94021 $95 Make checks payable to JEMS/AACF. Registration form (below) must be turned in with a check.

Bring:

Bible, notebook, pen, sleeping bag, personal items (toiletries, towel), warm clothes, camera, flashlight

PLEASE PRINT AND TURN IN THIS REGISTRATION FORM TO SOWER (Cindy Lin/Katherine Tsen/Jacquie Chang/Josh Ho/Chris Chuang) BY:January 24, 2013

______________________________________________________________________________________ RETREAT 2013 REGISTRATION FORM

(return this portion) Name: Permanent Address: Local Address: Phone: Email: Gender: Rides: ( ) Phone: Year: ( ) 1 2 3

M F 4 5 ____ I am a driver ___ I will need a ride on Friday 25th. The earliest I can leave is _____pm (please also provide this information on the doodle to help us organize rides)

Food or Drug Allergies/Conditions: Emergency Co ntact: Name: Phone: ( )

I agree to participate in programs, abide by camp regulations, and attend all stated meetings and services. I understand this is a Christian Retreat and the staff at any time reserves the right to send anyone away who chooses not to comply. Expenses for this will be charged to parents, my guardian, or me. I voluntarily assume all risk and responsibility for my physical condition and for my injuries or damages to my person or property that I might sustain. I voluntarily release and discharge JEMS, AACF, directors, officers, employees, or agents for any injury or damage to my person or property due to negligence, carelessness, or any other fault. It is further understood that this waiver, release and assumption of risk is binding on my heirs, personal representative(s), successors, and assigns. With my signature below, I acknowledge that I have read this waiver, release and assumption of risk and fully understand its terms, conditions and meanings.

Signature If under 18, guardian signature required Signature

Date Date