NLY Mission Trip/Retreat Registration 2025

New Life Youth Mission Trip/Retreat 2025

We are so excited for our Local Mission Trip/Retreat right here in Northern Illinois! Please fill-out this New Life Bible Church form we need on file for your student during the trip.
What:

The purpose of our Mission Trip is to continue to help students grow in their love for God and others through doing a practical hands-on ministry experience!

When: June 22-27

Who: Students 6th - 12th Grade (Ages 12-18yrs old)

Where: New Life Bible Church (June 22-25)/ Airbnb in Dixon, Illinois (June 25-27)

Partnering with: A variety of ministries (Rockford Rescue Mission, Pecatonica Food Pantry, Feed My Starving Children Ministry)

Address: New Life Bible Church: 2285 N. Hoisington Rd., Pecatonica, IL 61063

Cost: $125 total

$25 deposit is due with your registration

To Pay: You can pay with cash or check written to New Life Bible Church. To pay online, through the Tithe.ly website please visit: https://form.church/giving/NLBC and under "fund" choose “New Life Youth”

(If cost is an issue, please talk to Mia about possible scholarships)

For specific details on the mission trip, please refer to our printed info packet or contact Mia Spickler: 469-733-2722/ mia@newlifebible.church
Number of Students Attending
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Email
example@example.com
Student's Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Email
example@example.com
Student's Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Email
example@example.com
Student's Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Email
example@example.com
Student's Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender

MaleFemale
Email
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mission Trip/Retreat Schedule

*A physical copy is available in the packet*
Sunday, June 22nd

5pm: Meet at NLBC

5:30pm: Dinner

6pm: Worship/Mission Trip Orientation

8pm: Group Hang-out

10:30pm: Lights Out

Monday, June 23rd

7:30am: Breakfast

8am: Devotional

8:30am: Get ready to leave

8:45am: Leave for RRM (Rockford Rescue Mission)

9:30am: Arrive at RRM and staff tour

10am-12pm: Lunch Service at RRM

12:30pm: Lunch

1-5pm: NLBC Church Service Projects

5-8pm: Lake Summerset Lake Hangout

8pm: Return to New Life

10:30pm: Lights-out

Tuesday, June 24th

7:30am: Breakfast

8am: Devotional/Group Debrief

8:30am: Pack Lunches

9am: Leave for Pec Food Pantry

9:30am: Arrive at Pec Food Pantry

10am-11:30am: Pec Food Pantry Serving

12pm: Lunch

12:45pm: Leave for FMSC (Feed My Starving Children)

2:30-4pm: Serve at FMSC

4:30pm: Leave for New Life

5pm: Dinner at NLBC

6pm: Group Debrief

7:30pm: Movie/Popcorn

10:30pm: Lights Out

Wednesday, June 25th

7:30am: Breakfast

8am: Devotional

8:30am-10:30am: Get ready for NLBC Senior Luncheon

11am: Senior Luncheon

12:30-2pm: Senior Luncheon/Clean-up

2pm: Leave for Airbnb in Dixon, IL

3pm: Check-in to Airbnb in Dixon, IL

3-5pm: Settle-in/Hang-out

5:30pm: Dinner

6pm: Worship/Lesson

8pm: Group Hangout

10:30pm: Lights Out

Thursday, June 26th

7:30am: Breakfast

8am: Devotional

9am: Worship/Lesson

10:30-12pm: Group Free Time

12pm: Lunch

1pm: Worship/Lesson

2:30pm-5pm: Group Free Time

5:30pm: Dinner

6pm: Worship/Lesson

8pm: Group Hang-out

10:30pm: Lights Out

Friday, June 27th

7:30am: Breakfast

8am: Devotional

8:30am: Clean-up and pack things

10am: Leave Airbnb for NLBC

11am: Arrive at NLBC for parent pick-up

**Schedule is an estimate and could change. Please be flexible!**

Consent for Medical Treatment

In the case of an emergency, parents will be contacted immediately.
I , as the team member or parent guardian so hereby authorize the Agent, acting as my agent, to consent to any x-ray, examination, anesthetic, medical, or surgical diagnosis, or treatment and hospital care or service, which is deemed advisable by and is rendered under the general or specific supervision of any licensed physician and surgeon, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization given in advance of any specific diagnosis, treatment or hospital care being rendered, but is given to provide authority and power on the part of the Agent to give specific consent to any/all diagnosis, treatment, or hospital care which the above mentioned physician, in the exercise of his/her best judgement, may deem advisable. I hereby waive and release New Life Bible Church, and/or Agent from damage, liability, claims, or causes of action arising from or relating to decisions made, consents granted, or authorizations made by an Agent pursuant to this Consent to Treatment.

Signature of parent guardian/team member:
First Name Last Name
Date of Birth:
Insurance Company:
Policy #:

Medical Information
Does the student have allergies including asthma?
Please explain on the field provided
Is the student currently under medication?
Please provide the details, the name of the medication and period of intake

Contact Information in Case of Emergency

For any questions or details please contact Mia Spickler: 469-733-2722 or Justin Spickler: 815-979-0382
Name:

First NameLast Name
Phone Number:
Relation to student:
Name:

First NameLast Name
Phone Number:
Relation to student:

What to Bring

Please pack necessities due to limited luggage storage space.
-Paper Bible *can be provided by New Life*, Pen, Notebook (if want to take notes during devotionals)

-Casual Clothes that could possibly get dirty. Always bring extra just in case you want to change or get gross (please no spaghetti straps, crop tops, or short shorts)

-Swimsuit (We are planning to swim at Lake Summerset one evening) (Please bring a one-piece or wear a t-shirt over a two-piece)

-Jacket/Sweatshirt and pants/jeans if it gets colder at night

-Tennis shoes (may want to bring an extra pair that can get dirty) and flip-flops for shower

-Small backpack/water bottle (optional)

-Air Mattress (Cots are available at NLBC if needed)

-Sheets/Pillow/Blanket

-Towels (2) and washcloths

-Toiletries: soap, shampoo, toothbrush, toothpaste, deodorant, etc.

-Laundry bag or trash bag for dirty or wet clothes

-Prescription Medication (please keep in original package and fill out medication form. Place in zip-lock bag with student’s name cleary written on it)

-Sunscreen

-Spending money (optional) and/or money to buy snacks (at least $10)

(We will provide snacks and food as well)

What not to bring:

-We recommend not bringing tablets, laptops, smartwatches, etc. that could be lost or stolen--they are the student's responsibility. Students will not be able to use their phones during ministry time, devotionals, and meal-times, but can bring them.

-No knives, weapons, or anything that could be used as a weapon

-No fireworks

-No tobacco, drugs, or alcohol

-No complaining or bad attitudes!

Agreement and Expectations

Below is a basic overview of behavioral expectations for each student.
PURPOSE STATEMENT:

Our purpose is to grow in our love for God with all of our heart, soul, mind, and strength and to love our neighbors as ourselves in all we do!

Student Expectations:

-Love God

-Love Others

-Be Respectful to leaders and students/people we interact with

-Make safe choices

-Be Positive/ Flexible

-Be Servant-Hearted

-Be Technology Free/Undistracted

-Communicate issues or problems to a leader

‭‭
I blanks, as a participating student of New Life Youth, agree to and understand these expectations.
I give permission for my student to join New Life Youth of New Life Bible Church in any of the activities or trips sponsored by the Church, its staff and sponsors. I hereby release them from responsibility and liability for any illness or injury that my student may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity as agent for me to consent to any X-Ray exam, medical, dental, or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.
Signature of Parent or Guardian

Clear
Should be Empty:

New Life Youth Mission Trip/Retreat 2025

Mission Trip/Retreat Schedule

Consent for Medical Treatment

Medical Information

Contact Information in Case of Emergency

What to Bring

Agreement and Expectations