1) Print this WHOLE Web page
2) Fill out the Registration Slip
3) Have a parent sign the Medical Release Form
4) Make out a check payable to Northern Yearly Meeting
5) Mail BOTH forms and check (by MARCH 23) to:
Mary Klos, 100 Paoli St, Apt. 2, Verona, WI 53593
Who can come?
All 5th and 6th graders are invited to attend this retreat.
Additional FAPs (Friendly Adult Presences) are always welcome.
What does it cost?
$20 per family for food and expenses
(FAPs are free.)
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Registration
Spring NYM 5th and 6th Grade Retreat
March 27 to March 29, 2009
Minneapolis Friends Meeting, Minneapolis, Minnesota
NAME:______________________________________________________
ADDRESS:___________________________________________________
PHONE:__________________ E-MAIL____________________________
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MEDICAL RELEASE FORM
I give permission for my child(ren) named above to participate in the 5th and 6th Grade Friends Weekend at
Minneapolis, MN on March 27-29, 2009 and to participate in all planned program activities. I hereby release
Northern Yearly Meeting and Minneapolis Monthly Meeting, and their volunteers, from liability for any injury
or illness that my child may experience during the weekend. In the event of an emergency, I hereby authorize
the Weekend adult organizers to consent to any medical or surgical care advised by licensed health care
providers. I hereby release Northern Yearly Meeting and Minneapolis Monthly Meeting from any liability, legal
or financial, for emergency care provided to my child. I expect to be informed as soon as possible.
Parent’s Signature: ___________________________________________
Any special medical conditions or diet restrictions we should be aware of?
_________________________________________________________
In case of emergency, you can reach me at this number during the weekend of March 27-29, 2009:
_________________________________________________________