• Youth Retreat 2023

  • PERMISSION SLIP

  • Mt Carmel and Mt Pleasant Youth Retreat
    Jumonville Christian Camp
    887 Jumonville Rd, Hopwood, PA 15445
    April 14 – 16, 2023
    We will leave on Friday at 5 pm and return on Sunday at noon.
    Cost is $120.50 per person
    (Scholarships are available, please contact your Leader)
    Permission Slip and Medical Waiver

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  • STATEMENT OF CONSENT: By typing your name on this form in the box below, you are giving permission for the student(s) mentioned above to attend the Youth Retreat sponsored by Mt. Carmel Evangelical Presbyterian Church.

     

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    Pick a Date
  • Should you need to contact leadership during an event, call the following number: 724-601-2396 (Betty Tatum)

     

  • MTC

  • LIABILITY WAIVER

  • IMPORTANT: This is a student ministry event liability waiver and is for Mt Carmel and Mt Pleasant Youth Retreat
    Jumonville Christian Camp
    887 Jumonville Rd, Hopwood, PA 15445
    April 14 – 16, 2023
    Only one form per family is necessary.

  • By typing your name on this form in the box below, you are releasing liability for the student(s) mentioned above to the Youth Retreat sponsored by Mt. Carmel Evangelical Presbyterian Church.

  • Mt.Carmel Evangelical Presbyterian Church
    2720 Brodhead Road
    Aliquippa, PA 15001

  • MTC

  • LIABILITY RELEASE: In consideration of Mt. Carmel EPC allowing the student(s) to participate in student ministry events, we (I), the undersigned, do hereby release, forever discharge, and agree to hold harmless Mt. Carmel EPC, its trustees, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims, or demands for accidental personal injury or sickness, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the student(s) while involved in the student ministry events. We (I) the parent(s) or legal guardian(s) of this (these) student(s) hereby grant our (my) permission for the student(s) to participate fully in student ministry events, including trips away from the church premises. Furthermore, we (I) [and on behalf of our (my) minor student(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. Further, authorization and permission is hereby given to said Church to furnish any necessary transportation (within the limitations of church insurance and the law), food, and lodging for this (these) student(s). The undersigned further hereby agree to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful, or intentional acts of said student(s), including expenses incurred attendant thereto.
    MEDICAL TREATMENT PERMISSION: We (I) authorize an adult, in whose care the student(s) has (have) been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.
    EARLY RETURN HOME POLICY: Should it be necessary for the student(s) to return home due to medical reasons, disciplinary action, or otherwise, the undersigned shall assume all transportation costs and responsibility.
    TRANSPORTATION PERMISSION: The undersigned does alsy hereby give permission for the student(s) to ride in any vehicle driven by an approved volunteer leader while attending and participating in student ministry events sponsored by Mt. Carmel EPC. The student(s) and I understand that SEATBELTS SHALL BE WORN AT ALL TIMES during transportation.

    *Photo Release: We (I) give Mt. Carmel EPC the right to use video or still shot photography of the student(s) for any appropriate promotional or publicity use.

  •  / /
    Pick a Date
  • Should you need to contact leadership during an event, call the following number: 724-601-2396 Betty Tatum

    Mt.Carmel Evangelical Presbyterian Church
    2720 Brodhead Road
    Aliquippa, PA 15001

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