2021 HS Fall/Winter Retreat Registration
Friday, November 12 -- Sunday, November 14, 2021 at Lutherdale Bible Camp - Elkhorn, WI

Cost for Fall/Winter Retreat is $150/person.  Includes all meals, 2 nights of lodging, and activities.  
A $50 deposit is due Sunday, October 24th; and the remaining $100 is due Sunday, November 7th

Make checks payable to "St. John Lutheran Church" Memo line: 2021 Fall/Winter Retreat.  Please give payment to Pam Kornaus in the church office during office hours or on Sunday morning. (Do not leave in offering plate)
Please contact Pastor Evan if in need of a full or partial scholarship.

Questions?  Email pamkornaus@stjohnjoliet.org or evanmayhew@stjohnjoliet.org
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Name of Participant *
Address/City/Zip *
Parent Email Address *
Parent/Guardian Name(s) *
Parent Phone Number *
Emergency Contact and Phone Number *
Grade *
Medical Insurance Company & Policy Number (Please submit a copy [front & back] of your insurance card to St. John Lutheran Church via email to "pamkornaus@stjohnjoliet.org")
Please list allergies and medical conditions:
Please list any prescription medications your student may be taking:
Please check if it is permissible for us to administer the following medication for minor aches and pains: *
Required
Expectations and Permission: Please Review
As a parent/guardian, I have reviewed the information about the St. John High School Winter Retreat located at Lutherdale Bible Camp (N7891 US-12, Elkhorn, WI 53121) and give permission for my child to be involved in the overall activities on November 12-14, 2021. My child and I agree on the following expectations: participants are expected to follow Lutherdale Bible Camp and St. John rules. We agree that our participant will not leave early or come to retreat late unless arrangements are made in writing by email to Pastor Evan prior to the retreat. We agree participant will take transportation arranged by St. John, and no participant will be allowed to drive themselves to or from retreat.  We agree participant will conduct themselves as part of St. John Lutheran Church, and any rude language, abusive treatment, or illegal drugs seen on participants by volunteer or St. John staff will result in participants being sent home early, at the inconvenience and cost of the parents of the participant.  

The participant agrees to dress appropriately, bring all outdoor gear requested, and wea deodorant.  We will make every effort to ensure participant's safety, and participant agrees to follow all safety rules.  As parents, we authorize any treatment by an accredited urgent care, hospital and/or physician deemed necessary for the subject of the release in case of an emergency; St. John staff and volunteers will make every effort to contact parents if medical treatment is needed.  We understand the possibility of unforeseen hazards and know the inherent possibility of risk to participant.  We agree not to hold St. John Lutheran Church of Joliet, IL, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the participant on the retreat.  
Do you agree to the expectation and give permission for your child to attend the Fall/Winter Retreat? *
Date of Signature *
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Name of Church: *
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