You are on page 1of 1

Who: All Middle and High School aged youth.

What: Impact 2010

Where: Held at Camp Green Hills in Alexandria, PA.

When: July 28-July 31

What’s the Cost: Impact will cost $60 per person. This
includes everything. Feel free to bring extra spending money.
Scholarship money is available—see David Carter for
more info.

What to bring: money for dinner for Wednesday night, sleeping


bag, pillow, extra clothes, Bible, pen, notebook and your favorite
snack item to share with the group (chips, crackers, etc.).
Keep top half. Give bottom and deposit to a youth leader.

_____________________________ has my permission to attend Impact from July


28-July 31, 2010. In the event of illness, injury, or other emergency involving
my child, I understand that every effort will be made to contact me. If time is
of the essence, or if I cannot be reached, I give permission for Faith United
Methodist Church staff to act on my behalf to secure medical treatment as
necessary. I understand that it is my responsibility to pay for any medical
service required by my child during this outing. I absolve Faith United
Methodist Church from liability in acting on my behalf in this regard as long as
they are not grossly negligent.

I also understand that if my child does something unacceptable and deemed


worthy by the youth staff, I will be responsible for picking up my child from
Alexandria, PA.

Phone #: ________________________

_____________________ _________ _____________


Parent/Guardian Signature Date

*Please return registration and $40 deposit by Sunday,


May 9. The balance of $20 will be due upon departure.