Newtown Presbyterian Church Ski Trip to

Blue Mountain

DATE:                                    Saturday, March 8^th, 2008

TIMES:                                  8:30 am: Depart from Newtown Presb Church

                    11:30 pm: Return to the Newtown Presb. Church

COST:                            $70.00 per person: 

                                                lift tickets, ski rental, transportation, and breakfast 

              Please pay by check if possible made out to: 

             Newtown Presbyterian Church and deliver or mail to the church office

                              Add $8.00 for ski board rental instead of ski rent

                            Add $10.00 for evening tubing in addition to skiing

                            Subtract $15.00 if you bring your own skis or board

 LEADERSHIP:                      Rev. G.W. Blake Blakesley

TRANSPORTATION:          A 45 passenger School Bus with professional driver 

WHAT TO WEAR:               Layers! We never know how hot or cold it will be.

WHAT TO BRING:    Money for meals on the slopes

                                            we only provide breakfast 

MEDICAL FORM:  

         You MUST turn in a completed Medical Form with your registration. 

         We cannot allow anyone on the bus without a competed Medical Form!

DEADLINE:                          Thursday, March 6th, 2008

 QUESTIONS?  Call Blake or Lynn at 215-579-3399 and leave a message

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Ski Trip 2008

NEWTOWN PRESBYTERIAN CHURCH EMERGENCY MEDICAL FORM

Dear Parent/Guardian: In the event that your son/daughter requires medical attention during one of the Youth Group sponsored trips, we request your authorization to act until you may be reached. Please read and complete the statement below. Your signature will provide the authorization that we need.

Child’s Name______________________________________________ Birth Date______________

Home Address_____________________________________________________________________

_______________________________________________ Home Phone______________________

Father’s Name___________________________________ Work Phone ______________________

Mother’s Name___________________________________ Work Phone ______________________

Other Emergency Contact _________________________________ Phone ____________________

Relationship_________________________________________________

Health Insurance_______________________________Policy No. ___________________________

______________________________ Policy No. ____________________________

Physician’s Name __________________________________________________________________

Address________________________________________________ Phone ____________________

Note any medical condition(s) we should be aware of:______________________________________

_________________________________________________________________________________

 Allergies ________________________________Date of Last Tetanus Booster _________________

Present Medications________________________________________________________________

In the event that I cannot be reached and my son/daughter requires medical attention, I authorize a representative of the Newtown Presbyterian Church to act on my behalf.

Parent/Guardian Signature ___________________________________ Date__________________

Please initial the medications your child is permitted to receive.

Tylenol 1-2 tablets ___________ Benadryl 25mg_____________ Ibuprofen 200mg____________

Immodium 1-2 tablets_________ Sudafed 30mg______________ Dramamine 1-2 tablets_______