Pibel Camp Youth Group Trip

Please fill out this form and click submit.
The Youth Group is planning their final night for the 2023-2024 school year to be May 5.  We will have this last YG night at Pibel Bible Camp, in Ericson. 

A map to the location can be found here.

We will do a couple projects, so dress accordingly.  Then we will have supper there. 

We will leave the church property at 5pm, May 5.  Return time is estimated to be a little after 8pm. (IMPORTANT!  NO STUDENT, will be allowed to drive themselves, or others, unless prior permission has been given directly to Doug or Bev.  As a parent, if you would like to attend and can provide transportation for yourself and any students, please indicate that below.)

Contact Doug Durre @ 308-730-7489 or Bev Rice @ 308-870-1415 for questions.
 
 
 
 
 
 
Permission, Liability, and Medical release form

The following is a formal document required by our insurance whenever we take individuals off our property.
The details

This Liability and Medical Release Form along with all Claims In consideration is being accepted by Ord Christian Church for participation in the following: Pibel Bible Camp Youth Group Trip.


We (I), being 21 years of age or older, do for ourselves (myself) (and for and on behalf of my child-participant if said child is not 21 years of age or older) do hereby release, forever discharge and agree to hold harmless the Ord Christian Church, its pastor, pastor’s council, trustees, and any employee, agent, driver, or any other person connected with said church, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child-participant that occur while said child is participating in the above-described trip or activity. Furthermore, we (I) [and on behalf of our (my) child-participant if under the age of 21 years] hereby assume all risk of 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, food and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify said church, its directors, employees, and agents, 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.


Medical Release Form (If the participant has not attained the age of 21 years): We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him (her) to participate fully in said trip, and hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any. Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs. (Only participant need sign if 21 years of age or older. If under 21, one Parent/Guardian signature constitutes permission given by all parties with custodial care.
Please select one option.
 
 
 
 
Signature

This form must be SIGNED:
I (we) the Parent(s) or Legal Guardian(s) have read the above Liability and Medical Release.
 
 
Old School Form

If you prefer to print off our Permission Form, fill it out and send it with your student, you may do so here.

Description

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