We thank the trustees of the Zephyr Heritage Fund for their ongoing support of the Northern Lights Region Youth and Children's Ministry programs.  Through their generosity we are able to offer these deeply discounted rates for youth to attend Retreat and for adult volunteers to attend at no cost.

Note: Payment is the final step, found at the bottom of the page.

Please provide the information below.  If the address is the same as above for the attendee, there is no need to input that information again.  We do need an emergency phone number for the primary parent/guardian of all minors.

If the participant requires medical treatment while at retreat, the family's or participant's health insurance information will be used at the hospital.  Please provide that information below.  If you select "No Insurance" please type NA in the Carrier and Policy number sections.

This section helps our volunteer staff and medical personnel know about the participant's medical needs including:

• Any Medications to be taken during retreat
• Over the counter medications allowed or not allowed for minor participants
• Allergies, diet, nutrition
• General health questions and other information or clarification

Please list any other conditions, health history details of checked items above, and any special concerns/medical needs.

The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified minor participant. The minor has my/our permission to attend the indicated retreat program sponsored by the Northern Lights Region of the Christian Church (Disciples of Christ) as scheduled during the month of March 2020.

In case of medical emergency, I/we understand that every effort will be made to contact a parent or guardian of the participant. In the event I/We cannot be reached, I/We hereby grant permission to the camp staff to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for child while attending camp. I/We further release the event director(s), adult volunteers, onsite staff, and the Northern Lights Regional Christian Church (Disciples of Christ) from responsibility and liability for any accidents or illnesses occurring during camp. During travel to and from the event and during its duration, I consent for adult sponsors to provide basic first aid and to authorize emergency medical care or surgical treatment for my participant (if under 18) in the event I cannot be reached immediately for my permission.

I/We have read the Youth Covenant and acknowledge that I will be personally responsible for picking up my participant if they violate any part of the covenant.

Permission to Photograph

With your permission, the Region's Ministerial staff and our volunteer camp staff (counselors and directors) may photograph or video tape your minor for the express purpose of promoting the Region's Winter Retreat program or the Youth and Children's Ministries program through print media, digital media, or internet platforms.  Further, the staff of the facilities the Region rents to host our Summer Camp program (Gwinwood Christian Camp and Conference Center) have permission to photograph or video tape your child for the express purpose of promoting their facilities and ministry of hospitality through print media, digital media, or internet platforms. Below you can choose to NOT give your permission.

Youth Participant's Covenant

I agree to participate fully in this event and cooperate with all event leaders. I will not bring electronic games, devices used to watch shows/movies, tobacco, marijuana, alcohol, illegal drug/drug paraphernalia, vaping tools and supplies, fireworks, knives, firearms, other weapons, or anything intended to cause harm to myself or others. Cell phones are allowed as cameras and during free time only. I acknowledge that if I break this covenant or do anything to harm myself or others on the event site, I will be sent home at the expense of my parent(s)/guardian(s).