We are taking our youth group north for an unforgettable weekend in the Northwoods at Fort Wilderness!! Winter retreats at Fort’s Main Camp are known to be a highlight of the school year. Imagine the shared experiences, special conversations and deeper relationships you’ll experience.

Relationships deepen with shared experiences

Friendly game or competitive match – you decide!

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This form contains all the information you need to supply both to Fort Wilderness and to Southbrook & Meadowbrook Church.

Southbrook & Meadowbrook Church Weekend Retreat Group

Campers and chaperones, complete this form in preparation for your Weekend Retreat at Fort Wilderness!

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Camper/Chaperone Name*

First Last

Parent/Guardian Name

First Last

Camper/Chaperone Phone

Camper/Chaperone Email

Parent/Guardian Phone

Parent/Guardian Email

Camper/Chaperone Birthdate*

MM slash DD slash YYYY

Gender*

Male

Female

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please share any information about food allergies:

Are you a camper or chaperone?*

Camper

Chaperone

What church do you attend?

Southbrook

Meadowbrook

Are you currently under the age of 18?*

Yes

Acknowledgement of Risk Form*

I agree to the Agreement & Acknowledgement of Risk

Fort Wilderness Ministries (FWM)

Participant’s Agreement & Acknowledgement of Risk

Although Fort Wilderness Ministries (FWM) has taken reasonable steps to provide you with Staff, equipment, and appropriate support so you can enjoy our programs and activities, these activities are not without risk. Certain risks cannot be eliminated without destroying the unique character of the activity, which could result in, but not limited to, the following: loss or damage to your equipment, financial damage, sickness (including communicable diseases), emotional stress, bodily and/or personal injury, a potential for permanent disability and even death. It is important for us to inform you of the inherent risks.

In consideration for the opportunity to participate in the registered event, and the services of Fort Wilderness, its staff, volunteers, and all other persons associated with its ministry, I, the undersigned on behalf of my family and all those under my care, agree as follows:

The participant named above is physically able to participate in all camp activities and to my knowledge does not have an illness or any communicable disease which could be passed on to staff or other campers

– I accept and acknowledge that many of the activities at FWM and any of its subsidiaries, affiliates, or other related organizations have a known and unknown associated risk and I voluntarily accept the risks described above with participation in and transportation to such activities
– I accept personal financial responsibility for any injury or other loss sustained during any and all activities or during transportation to and from the activities, as well as for any medical treatment that is authorized by FWM and rendered to the participant named above
– I release and promise to indemnify, defend, and hold harmless FWM and any of its subsidiaries, affiliates, or other related organizations for any injury or adverse consequence arising directly or indirectly from participating in any and all activities or transportation to and from the activities, whether such injury arises out of the actions of FWM, the participant named above, or otherwise
– I give FWM and any of its subsidiaries, affiliates, or other related organizations permission to use the image(s) of the participant named above for promotional materials, which may include use in social networks & websites

Parent/Guardian Acknowledgement of Risk

Because you are currently under 18, please have your parent/guardian review and agree to the Acknowledgement of Risk Form.

Acknowledgement of Risk Form*

I agree to the Agreement & Acknowledgement of Risk

Fort Wilderness Ministries (FWM)

Participant’s Agreement & Acknowledgement of Risk

Although Fort Wilderness Ministries (FWM) has taken reasonable steps to provide you with Staff, equipment, and appropriate support so you can enjoy our programs and activities, these activities are not without risk. Certain risks cannot be eliminated without destroying the unique character of the activity, which could result in, but not limited to, the following: loss or damage to your equipment, financial damage, sickness (including communicable diseases), emotional stress, bodily and/or personal injury, a potential for permanent disability and even death. It is important for us to inform you of the inherent risks.

In consideration for the opportunity to participate in the registered event, and the services of Fort Wilderness, its staff, volunteers, and all other persons associated with its ministry, I, the undersigned on behalf of my family and all those under my care, agree as follows:

The participant named above is physically able to participate in all camp activities and to my knowledge does not have an illness or any communicable disease which could be passed on to staff or other campers

– I accept and acknowledge that many of the activities at FWM has a known and unknown associated risk and I voluntarily accept the risks described above with participation in and transportation to such activities
– I accept personal financial responsibility for any injury or other loss sustained during any and all activities or during transportation to and from the activities, as well as for any medical treatment that is authorized by FWM and rendered to the participant named above
– I release and promise to indemnify, defend, and hold harmless FWM for any injury or adverse consequence arising directly or indirectly from participating in any and all activities or transportation to and from the activities, whether such injury arises out of the actions of FWM, the participant named above, or otherwise
– I give FWM permission to use the image(s) of the participant named above for promotional materials, which may include use in social networks & websites

Name of the Parent/Guardian Signing Agreement & Acknowledgement of Risk Form*

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Southbrook & Meadowbrook Church Winter Retreat

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Southbrook & Meadowbrook Church Weekend Retreat Group

Parent/Guardian Acknowledgement of Risk

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