Sugar Creek Fellowship Fall Retreat

Sugar Creek Fellowship Fall Retreat

Retreat Theme: He Is
WHEN
Friday, October 24th - Sunday, October 26th, 2025

WHERE
Connxtion Retreat Center. 277 W Thoburn Avenue, Upland, IN 46989

WHAT
A weekend of games, swimming, music, speakers, laughter, and a whole lot more!

PRICE
$50 Includes: food, lodging, and a t-shirt. Students will need money for Ivanhoes (979 S Main St, Upland, IN 46989) on Saturday night for Ice Cream. Please turn in your $50 payment to Levi Johnson in person, on Venmo, or mail your payment to: 508 E. Van Buren St. Columbia City, IN 46725. Please make checks payable to: Sugar Creek Fellowship Church.

HOW TO SIGN UP/PAY
Fill out this form, click submit, mail cash/check to Levi Johnson @ 508 E. Van Buren St. Columbia City, IN 46725, or Venmo payment to @Levi-Johnson-93

TRANSPORTATION INFO
Students will be transported by Sugar Creek Fellowship volunteers to the retreat center. Students will need to be dropped off at the church (3531 W. 800 S. South Whitley, IN 46787) on October 24th by 5:00PM. On October 26th, students will be transported back to the church and will arrive home around 1PM

ADDITIONAL INFO
Forms and payment should be turned in by October 3rd, 2025. Any Registrations after October 3rd will not be guaranteed a T-shirt.
Registration Forms

Student Info
Student Name

First NameLast Name
Grade
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-shirt Size
Medical Info
My Student has Allergies
List of Allergies
If my Student complains of a headache/pain, I give permission for the following to be administered: (Please check any choice that would be okay with you.)

Other
My Student has medical insurance
Name of Insurance Co.
Policy #
Emergency Contact
Emergency Contact #1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address (If different from student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact #2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address (If different from student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email (For parent letter)
example@example.com
Parent Permission And Medical Liability Release Statement
As parent/legal guardian of this student, I have reviewed the information about the youth ministry activity/event and give my permission for the subject of this release to be involved in the overall activities connected with the event. I have reviewed the rules of the activity and agree that the subject of this release will abide by them. I also acknowledge that if the subject of the release has to return home early for discipline violations, it will be at my expense.
I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of the subject of this release during the 2025-2026 school year to be used, distributed, or shown as Sugar Creek Fellowship determines.
I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I can not be reached, in an emergency, during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand all reasonable safety precautions will be taken at all times by Sugar Creek Fellowship and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Sugar Creek Fellowship, its leaders, its employees, and/or volunteer staff liable for damages, losses, diseases, injuries, and/or death, incurred by the subject of this form.
Parent/Guardian

Printed NameDate
Parent/Guardian Signature

Payment
How are you planning to pay for the retreat?
I understand that until I submit payment, my student is not officially signed up for the Retreat

Sponsor Form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
T-shirt Size

Please Call, Text, Or Email Levi Johnson (260)452-4324, johnson_5384@hotmail.com with any questions
Should be Empty:

Sugar Creek Fellowship Fall Retreat

Student Info

Medical Info

Emergency Contact

Parent Permission And Medical Liability Release Statement

Payment

Sponsor Form