St. John Lutheran Church

Camp Luther Winter Retreat

January 17-19, 2025
Hello Awesome St. John Youth & Parents,

St. John Youth Group is heading to Camp Luther for the Winter Retreat, January 17-19, 2025 - and we don't want you to miss this wonderful opportunity.

If your son or daughter would like to attend, please fill out the form below.

We need a response from parents & youth by Sunday, December 8th if you plan on attending, as the space will fill up fast.

WHO:
All youth groupers in the 6-12th grades are invited to attend.

WHERE:
Camp Luther!
Three Lakes, WI

We plan to meet at the church and carpool up to Camp. It is about a 2 hour drive.

WHEN:
January 17-19, 2025

WHAT:
Come to Camp Luther for a fun time while growing in your faith.
Winter Activity Options:
- Broomball
- Downhill Tubing
- Cross-Country Skiing
- Snowshoeing
- Snow Ga Ga Ball
- Campfire Snack Pack
- Bible Study
HOW MUCH:
$85 per youth

For additional information go to: campluther.com/winteryouth
Yes, my child(ren) has (have) my permission to attend the Camp Luther Retreat with St. John Lutheran Church and their youth leaders.*

YesNo
1) Child's Name*

First NameLast Name
Gender*

MaleFemale
Youth Grade Level*
Youth Cell #

Area CodePhone Number
2) Child's Name

First NameLast Name
Gender

MaleFemale
Youth Grade Level
Youth Cell #

Area CodePhone Number
3) Child's Name

First NameLast Name
Gender

MaleFemale
Youth Grade Level
Youth Cell #

Area CodePhone Number
List All Allergies or Dietary Concerns Below for each Child
Comments / Questions:
I, (the individual named below), the parent or guardian of (the above named child(ren)), give my permission for my son/daughter to travel to and attend the above named function and all events related with above named function, that St. John Lutheran Church is attending on the dates stated above in Part A. This consent form is valid only for the event & dates listed: Camp Luther Winter Retreat, January 17-19, 2025
I,(the individual named below), agree and consent to having the staff members and chaperons, under whose support the program is conducted, and any other worker in the program approved as parent, secure any emergency medical care or treatment that may be necessary for my child during the entire outing, including the trip to and from the destination. I give my consent to any examination, x-ray, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is rendered under supervision of any physician or surgical licensed under the provisions of the Medical Practice Act, whether that treatment is given at the office of the physician or at a hospital. I further assume all responsibility for the decisions made, for the emergency care and treatment received by my child, and the costs incurred for such care.
Parent or Guardian Signature*

Clear
Date*

MonthDayYear
Date
I am aware that the Retreat to Camp Luther is $85 per child and will cover the cost for my child to attend (please checks made payable to St. John or use the PayPal feature below)

YesNoOur family is in need of assistance to attend
Parents Name:*

First NameLast Name
Parent's Email:*
example@example.com
Parents Phone #*

Area CodePhone Number
I will submit payment via:*

CheckPayPal - use feature below
Winter Retreat Payment
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Camp Luther Winter Retreat$87.00
Includes a $2.00 processing fee

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Camp Luther Winter Retreat