You are on page 1of 1

Who: All youth 14 years or older by July 11.

What: Harrisburg Summer Mission Trip

Where: Harrisburg, PA.

When: July 11- July 16

What’s the Cost: The cost per person is $50, but all of that
money should be fundraised. After fundraising, you will be
refunded however much was raised

What to bring: sleeping bag, pillow, old clothes, Bible, pen

Keep top half. Give bottom and deposit to a youth leader.

_____________________________ has my permission to attend the Harrisburg

Mission Trip from July 11-July 16, 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
Harrisburg, PA.

Phone #: ________________________

_____________________ _________ _____________

Parent/Guardian Signature Date

*Please return registration and $50 deposit by Sunday, April

25. A partial or full refund will be issued after fundraising.