MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has 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.

Please list any medications your child will need to take during the retreat and how often they need to be taken. Medications should be given to retreat staff upon arrival and an adult will maintain your child's medications schedule.

Cost:
Registration and participation, including all expenses, is $55.00

Payment Methods:
1) Checks
Checks should be made payable to ESDUMC
Send To: District Office
                P.O. Box 317
                Parksley, VA 23421
                       
            -OR-

2) Pay Online:
Once you press the Submit button, you will be given the option to pay online through paypal.

Please contact the Event Planners if you have any questions.
Event Coordinator: Peter Surran (757) 709-5090, peter.surran@gmail.com
Event Assistant Coordinator: Michael Henry (757) 442-7836, ootbay@verizon.net
District Office Manager: Connie Owens (757) 665-6295, (Contact if you have questions regarding scholarships.)

Participants should arrive at Occohannock on the Bay March 31st at 6:00pm and should be picked up on April 2nd at 10:00am. Family and friends are invited to join us for closing worship on Sunday October 18th at 9:00am

The undersigned does hereby give permission for our child to attend and participate in "Branching Out", an Eastern Shore District UMC Youth Ministry Retreat, Friday, March 31, 2017 at 6 pm through Sunday, April 2, at 10 am. This event is sponsored by the Eastern Shore District and Virginia Conference of the United Methodist Church.

LIABILITY RELEASE: In consideration of The Virginia Conference allowing the participant to participate in children or youth ministry activities, I, the undersigned, do hereby release, forever discharge and agree to hold harmless The Virginia Conference, its directors, employees, volunteers and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant while involved in the children/youth activities. I the parent(s) or legal guardian(s) of this participant hereby grant our (my) permission for the participant to participate fully in youth ministry activities, including trips away from the church premises. Furthermore, we (I) [and on behalf of our (my) minor participant(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 Participant. 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 Participant, including expenses incurred attendant thereto. I the parent or guardian give permission for the use of pictures or videos that are taken to promote the ministry for future events. I understand that the pictures and or video could be placed on Occohannock on the Bay's website, facebook page, and promotional CD/Dvd.

EARLY RETURN HOME POLICY: Should it be necessary for the participant 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 also hereby give permission for our (my) youth to ride in any vehicle driven by an approved ADULT chaperone while attending and participating in activities sponsored by The Virginia Conference. My child/youth and I understand that SEAT BELTS SHALL BE WORN AT ALL TIMES during transportation.

Youth Covenant of Conduct: 
During the meetings and events under the sponsorship and guidance of the Virginia Conference, I recognize that I am a representative of the Christian Community and I am responsible for my actions. I understand that by signing this Covenant, I agree to abide by the following guidelines:

 I Shall:

1. Recognize that everyone in the group is a part of the body of Christ. I will embrace inclusiveness by making sure that everyone feels welcome and important.
2. Respect the physical and emotional well-being of others by “doing unto them as I would have them do unto me.” (This includes refraining from harsh play or violence, refraining from harmful jokes, respecting the need for sleep, etc.)
3. Respect the health of my own body by refraining from the use of tobacco, alcohol, and illegal drugs. I understand that the use of these substances is absolutely prohibited.
4. Respect the things I use and the property of places I visit. The areas used for all events, including transportation, shall be left clean. ? Participate fully in ALL scheduled group activities and abide by additional group guidelines made during Annual Conference.
5. Act appropriately with members of the opposite sex. This means no couples alone at any time, and no public displays of affection.
6. Follow all instructions given by group leaders and chaperones without protest. (This does not mean an instruction may not be politely and discretely questioned if it seems unreasonable).
7. Stay within the group or assigned sub-group at all times. I will not wander of f alone or leave the activity site unless granted permission by an adult, and I will report for all designated check-in times.
8. Hold safety in the highest regard and refrain from compromising my own safety or another's safety .
9. Provide a trusting environment for my peers. When others share something about themselves in a group discussion, I will not repeat that information to other friends outside of the group. 
10. I shall leave my cell phone, tablet, or other devices at home or in my cabin and will only bring it out when allowed.

Guidelines for Consequences:
Consequences will focus on restoring peace with reconciliation among the parties involved. The goal of resolving each problem will be growth and learning through repentance and forgiveness. Any problems encountered will be handled within the group and by the adult leaders to the extent that this is possible. However, should a situation persist or become uncontrollable, the parent/guardian will be contacted and informed of the problem. Should the situation be urgent, the parent/guardian will be contacted immediately and will be responsible for picking up the youth from an event or providing for his/her transportation home. 

Please no cell phones:

Child/Youth and Parent/Guardian Signature:
In signing this covenant, I vow that I have read and understand these guidelines. I recognize that a covenant is a binding promise, and my signature is testimony that I agree to adhere to the provisions of this covenant.