Rocky Mountain HigH 2008

REgistRation FoRM

Please fill out both sides of the registration form completely and lEgibly. Forms will be sent back if incomplete or unreadable.

inFoRMation about you
First name _____________________________________________ last name ____________________________________________ address _________________________________________________________________________________________________ city ___________________________________________________________________state ____________Zip _______________ Home Phone ( ) _________________________________ Email ________________________________________________

birthdate (month/day/year) _____________/____________/_____________ check male/female: check adult/student: ____ Male ____ adult ____ Female ____ student if you are a student, circle your grade for 2007-2008 school year: 9 10 11 12

Please list the name and city of the church you are attending RMH ’08 with: ____________________________________________________________ contact leader ________________________________________________ contact Phone ( ) ____________________________

insuRancE inFoRMation/EMERgEncy contact
adult lEadERs only studEnt PaRticiPants only
If you are an adult leader, fill out this column. Do you have insurance? YES NO If YES, please list insurance company and group/policy number: Insurance Company:_____________________________________ Group/Policy Number:__________________________________ Emergency Contact:______________________________________

If you are a student participant, your parent or adult guardian must fill out this column. Do you and your son/daughter have insurance? YES NO If YES, please list insurance company and group/policy number: Insurance Company:___________________________________________________ Group/Policy Number:_________________________________________________ Parent/Guardian Name(s):___________________________________________________

Please list all important numbers for emergency contact: Home Phone: (_________)_______________________________ Work Phone: (_________)_______________________________ Cell Phone: (_________)________________________________ Are you in general good health and able to participate in all general RMH ‘08 activities? YES NO If NO, please explain limitations: Will you be on any medications while at RMH ’08? YES NO If YES, please list medications: Please list any other medical alerts or precautions that the RMH Leadership and Medical Team should be aware of (attach separate sheet if necessary):

Please list all important numbers for parent/guardian: Home Phone: (_________)_____________________________________________ Work Phone: (_________)______________________________________________ Cell Phone: (_________)_______________________________________________ Is your son/daughter in general good health and able to participate in all general RMH ‘08 activities? YES NO If NO, please explain his/her limitations:

Will your son/daughter be on any medications while at RMH ’08? YES NO If YES, please list medications:

Please list any other medical alerts or precautions that the RMH Leadership and Medical Team should be aware of (attach separate sheet if necessary): _____ I need to be in a handicap accessible room if available.
In signing this registration form, I hereby certify that the information on the entire form is correct and I hereby give my permission for the use of photographs and videos including my son/daughter for event publicity and placement on the RMH webpage; for my son/daughter to be transported in privately owned vehicles to and from all out-of-camp activities; for my son/daughter to participate in all approved out-of-camp activities and recreation; and for the release of medical records in case of illness or injury. In case of medical emergency, I understand that every effort will be made to contact myself, the parent/guardian listed above. In the event that I cannot be reached, I hereby give my permission to the physician or medical staff selected by the RMH Director to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my son/daughter as named herein. I understand that if my son/daughter is involved in the use of alcohol, drugs, or some other gross infraction of the stated Guidelines (see page 4) or is grossly insubordinate to RMH authorities, he/she may be sent home at my own expense.

_____ I need to be in a handicap accessible room if available.
In signing this registration form, I hereby certify that the information on the entire form is correct and I hereby give my permission for the use of photographs and videos including myself for event publicity and placement on the RMH webpage; for myself to be transported in privately owned vehicles to and from all out-of-camp activities; for myself to participate in all approved out-of-camp activities and recreation; and for the release of medical records in case of illness or injury. In case of medical emergency, I understand that every effort will be made to contact the emergency contact person listed above. In the event that this person(s) cannot be reached, I hereby give my permission to the physician or medical staff selected by the RMH Director to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for myself as named herein. I understand that if I am involved in the use of alcohol, drugs, or some other gross infraction of the stated Guidelines (see page 4) or am grossly insubordinate to RMH authorities, I may be sent home at my expense.

____________________________________________________________

Signature of ADULT LEADER

(mandatory)

Date

________________________________________________________________________ Signature of PARENT/GUARDIAN (mandatory) Date

7

Please fill out the following sections in order to complete the registration process for Rocky Mountain High. All yellow boxes are required and will be sent back if not completed; all blue boxes are optional.

lEadERsHiP sEMinaR - Early Morning leadership Workshop - 6:00 am (optional)
______ I am interested in participating in the 6:00 am Leadership Workshop at RMH. See page 4 for details.

sEMinaR cHoicEs

Put the number of the seminar, in order of preference, in the blanks below. These blanks should only contain the numbers 1 - 6; each number should only be used once. See page 4 for detailed descriptions of seminars. 1. __________ 2. __________ 3. __________ 4. __________ 5. __________ 6. __________

1. 2. 3. 4. 5. 6.

Ben Glenn Mike Williams Rich Praytor Dannah Gresch Mike Yankoski Meet the Band

REcREation cHoicEs

Put the letter of the recreation, in order of preference, in the blanks below. These blanks should only contain the letters O, S, T, or U. Since every participant will automatically be assigned one afternoon On-Campus, the letter O has been filled in the first blank for you. You may select O for On-Campus as many times as you wish; the other letters should only be used once. See page 5 for detailed description of recreation. O 1. ____________ 2. _____________ 3. _____________ 4. _____________

O On-Campus S Sightseeing/Shopping T Trail Ridge Bus Tour U Alluvial Fan/Bear Lake

REcREation Plus cHoicEs (optional)

Put the letter of the recreation PLUS, in order of preference, in the blanks below. These blanks should only contain the letter A - L. You are NOT required to sign up for recreation PLUS options, and you should only put those options you wish to participate in. If you do, you will get assigned only one of your choices, as long as there is availability, and this may or may not be your first selection(s). See page 5 for detailed descriptions of recreation PLUS. 1. ____________ 2.____________ 3. ____________ 4. ____________ 5. ____________

A River Rafting B Colorado Biking C Wilderness Tour D Waterpark E Rock Climbing F Mountain Hiking G Golfing H Hallets Peak Climb I Horseback Riding (90min) J Horseback Riding (60min) K High Ropes Course L Climbing Wall

Rocky Mountain HigH PaRticiPant agREEMEnt
In signing this form, I acknowledge I have read the Guidelines for Rocky ‘08 as listed on page 4, and I agree to follow and abide by these guidelines while at Rocky Mountain High, July 26-30, 2008. __________________________________________________________________________________________________________ Participant Signature Date Once you have completely filled out the registration form: a) Check with church or youth leaders about registration payment

~ REQuiREd ~

Individual participants are encouraged to make checks payable to their church; the church is then highly encouraged to send in ONE check payable to the Synod of the Heartland. Registrations will not be processed unless full payment is received.

b) Make appropriate payment for registration and bussing (if applicable)

c) Turn in both registration form and payment to church or youth leaders Registration forms must be completely filled out LEGIBLY and the participant agreement
signed or they will be sent back for completion and correction.

ROCKY MOUNTAIN HIGH

d) Church or youth leaders are then responsible to send in all registration forms and payment for the entire church group