Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th Big House 2015 June 11-14 Bellville, TX Big House is a summer mission trip for students who have completed 6th-8th grade. We spend 2 days out serving in the community and then worship with the host church on Sunday morning. The next page includes instructions to register for the trip. The pages behind that are the forms that need to be filled out. Contact Heather if you have any questions.
Big House Registration Instructions & Scholarship Information Registration Steps 1. Fill out and turn in all necessary paperwork. This includes bringing in your insurance card so that we can make a copy and having your medical release form notarized. 2. Pay at least the $50 deposit for the trip. This should be accompanied with a scholarship application where you can fill out a payment plan or list your need for a scholarship. You ll see more information about that below. 3. At this point your registration will be accepted as long as we are still meeting the required adult to student ratio that the trip requires. 4. If you are a student who does not regularly participate in Moody s student ministry, the parents and the student will need to schedule a meeting with Heather before registration will be finalized. Scholarship Requirements 1. Have all paperwork ready to turn in. 2. Scholarships will be offered to cover half of the cost of the trip. At the time paperwork is due, the deposit will need to be turned in along with the paperwork. After that, payment plans can be setup to finish paying the rest of your portion of the cost. 3. You must attend at least 10 student ministry programs between now and the beginning of summer. This includes Sunday school/church; Crossover, JV or Varsity; or any other special events that we have going on. 4. Participated in at least one of the fundraising events: pumpkin patch, Seaside Treasure Festival, Tacky Prom, Pancake Supper, etc. Meeting all of these requirements will give you priority in the giving of the scholarship funds. Those who cannot meet the requirements will be considered after the other students. A few other items 1. All trips must be paid in full before students can leave with us. We will not be able to take a student on a trip with an outstanding balance. 2. If a student chooses not to attend the trip, a refund will be given only if we can find another student to attend in their place. If it s early enough that the organization will offer a partial refund, we will pass that on to you. 3. If you receive a scholarship for a 2015 trip and do not attend without appropriate notice, you will not be considered for a scholarship in 2016 until the fee from the 2015 trip is paid back in full.
Big House Registration Form Fill out in Black ink - Send original and a copy to BIG HOUSE office and keep a copy for your records All Youth Must Have Completed Grade 6. All Adults Must Be 21 or older. College Students must be 18. Please Mark With an X the Appropriate Box: Youth Adult College Student Last Name First Name Preferred Name 10 Digit Home Phone M F Street Address City Zip Date of Birth Age Sex (Circle) Participating Church Name Participant Email Address Cell Phone # of Participating Adult OR Cell Phone # or Parent/Guardian Parent/Guardian Name(s) Emergency Contact Name (other than parent) Emergency Contact Phone # List All Medications That Will Be Taken At Camp Date of Last Tetanus Employer Name (Adult/Parent) 6 7 8 List All Medical Problems/Allergies/Issues we should be aware of Carpentry Painting Yard Work List Any Special Dietary Needs Music Rank Your Skill In The Areas Above 1=Never Administrative 2=Occasionally 3=Often Grade Completed, Youth Only Food Service Y N S M L XL 2XL 3XL Adult T Shirt Size, Please Circle Have you attended BIG HOUSE? How many times? Last Year Attended Type of Vehicle You Will Drive at BIG HOUSE (Age 21 & Older) & Car Insurance Provider # of Seatbelts Including Driver Medical Insurance Information: Insurance Company Name Policy Holder Group Number Insurance Co. Verification Phone # List First and Last Names of Other Family Members Attending This Work Camp Covenant Agreement/Release Form By my signature below I acknowledge that I have read and understand the BIG HOUSE TEXAS Covenant of Conduct and agree to abide by it. I affirm that all the information on this BIG HOUSE TEXAS Individual Registration form is correct. X Safe Sanctuary Approved Participant s Signature (youth/adult/young adult) Date (to be checked by Church Coordinator) X My child may be photographed for Parent/Legal Guardian Signature (required for all youth Date BIG HOUSE purposes Y or N
Big House Texas Covenant of Conduct!! BIG!HOUSE!TEXAS!is#for#those#willing#to#do#plain,#honest#sweaty,#awesome#work# to#help#others!#few#rules#are#needed#since#participants#join#with#common#goals#of# work,#service#and#christian#fellowship.#the#rules#are#to#enhance#the#work#camp# experience#and#to#continue#the#reputation#of#big#house#as#a#caring,#effective#and# responsible#group#of#people.# It!is!impossible!to!cover!every!rule!of!safety!and!appropriate!behavior,! but!the!rules!listed!below!are!a!few!of!the!most!basic!ones!necessary!for!a!safe,! enriching!experience:! 1.#Conduct#will#be#appropriate#for#a#church#activity.# 2.#Participants#will#conduct#themselves#in#a#thoughtful#and#safe#manner#at#all#times.# 3.#Participants#will#follow#the#directions#of#the#camp#leadership;#insubordination#won t#be# tolerated#by#youth#or#adults.#the#camp#director#on#advisement#by#the# Executive#Director#has#the#authority#to#do#what#he/she#deems#necessary.# 4.#Possession#or#consumption#of#alcohol,#illegal#drugs,#tobacco,#or#weapons#is#strictly#prohibited.# 5.#No#one#may#enter#the#dorm#area#of#the#opposite#sex.# 6.#Everyone#participates#in#all#events.#Adults#included!# 7.#Radios,#CD#players,#MP#3 s,#dvd s#game#boys,#cell#phones#(for#youth)#etc.#are#not# allowed.#no#music#will#be#allowed#on#the#worksite.#big#house#texas#will#not# replace#any#lost#or#stolen#items.# 8.#Refer#to#the#page#on#dress#code.#No#one#may#wear#clothes#that#might#be# objectionable.#the#camp#director#has#the#discretion#to#do#what#is#necessary#in# dealing#with#inappropriate#clothing.# 9.#No#one#may#leave#the#base#camp#at#anytime#during#camp#unless#authorized#by#the# Camp#Director#to#do#so.# 10.#No#youth#or#adult#may#arrive#at#camp#late#or#leave#camp#early.#This#takes#away# from#the#camp#experience.# 11.#No#paint#fights# #painting#yourself#or#others!#no#water#balloons,#water#guns,#or#slip#and#slides#on#the#worksite!# Vehicle!Rules!are!as!follows:! A.#No#youth#participant#may#ride#as#a#passenger#in#a#vehicle#driven#by#anyone# under#the#age#of#21#during#camp#except#as#stipulated#in#emergency#procedures.# B.#No#one#may#ride#in#the#back#of#a#truck#or#trailer.#All#people#must#ride#inside#the# vehicles#with#seat#belts#buckled#at#all#times.# C.#All#safe#driving#procedures#must#be#observed#and#drivers#must#have#current#drivers#license# and#insurance.# D.#NO#YOUTH#participant#may#drive#a#vehicle#during#camp.# BIG#HOUSE#TEXAS#reserves#the#right#to#determine#any#inappropriate#behavior# and#to#send#a#participant#home#in#disciplinary#cases!# Press!and!Medical!Release! 1.##By#signing#this#agreement#you#are#releasing#your#image#to#be#reproduced#for#promotional## materials#as#needed#by#big#house#texas.# 2.##By#signing#this#agreement#you#agree#to#release#any#decisions#regarding#medical#treatment# to#the#big#house#texas#staff#at#camp#attending.### 3.#By#signing#this#agreement#you#agree#to#indemnify#and#hold#harmless#BIG#HOUSE#TEXAS,#its#employees,#agents,# and#leaders#for#any#damage#resulting#from#negligent#or#intentional#acts#committed#by#the#minor#or#adult.# 4.#By#signing#this#agreement#you#are#saying#that#you#understand#that#travel#between#home#and#camp#is#your# responsibility#and#you#will#not#hold#big#house#texas#responsible#for#accidents#or#injury#related#to#travel#to#and# from#camp.# Medication Information Form
Please use this space to share any additional information such as medications, or special needs that could not be written on the main form.
Moody Memorial FUMC 2803 53 rd Street Galveston, Texas 77551 Office: 409-744-4526 Fax: 409-744-0508 Medical Release and Consent Form The Link Student Ministries (Valid through 12/31/2015) Student Information Circle One MALE OR FEMALE / / Name: First (Nickname, if any) Middle Last Date of Birth ( ) Address: Street City State Zip Home Telephone Number Current School Grade T-shirt size Parent/Guardian Information Home Situation (Who does student live with? Who has custodial rights?) Name Relationship to Youth Named Name Relationship to Youth Named ( ) ( ) ( ) ( ) Home Telephone Pager/Cell Phone Home Telephone Pager/Cell Phone ( ) ( ) Employer Work Telephone Employer Work Telephone Emergency Contact ( ) ( ) Name Relationship to Youth Named Home Telephone Pager/Cell Phone Health Information Copy of front & back of insurance card attached? ( ) Family Physician Telephone Number Primary Medical Insurance Company/Group Date of Last Tetanus Shot: Policy Number Responsible Party Medications (Include both prescription and over the counter medications the student takes routinely.). Allergies: _ General Health Concerns/Past Medical History. Please include any information on any emotional/behavioral conditions we should know about for health/safety reasons. How do you typically manage these conditions? (Please note: This information will be kept confidential.)
As parent(s), legal guardian(s), or custodian(s) of, I/we permit him/her to participate in all officially supervised Moody Memorial FUMC Ministry Programs and Activities for which he/she is registered. I knowingly release, absolve, indemnify, and hold harmless Moody Memorial FUMC., its Members, Trustees, Boards, Leadership, and Staff, as well as counselors, organizers, workers and all others acting on behalf of Moody Memorial FUMC or its programs and activities, from all claims that might result from any accident, personal injury, illness and/or death to the youth named arising out of participation in such programs and activities. In the event that my child requires medical or dental attention while attending a Moody Memorial FUMC Ministries event, I understand that an adult sponsor of the event will make every reasonable attempt to contact me. In the event that I cannot be contacted, I consent to any medical attention deemed appropriate. In the event that treatment is called for, which the medical provider refuses to administer without consent, I hereby authorize the Student Ministries Staff or any other adult volunteer to give such consent for me if I cannot be contacted immediately or, because of an emergency, there is no time or opportunity to make contact. In the event that it is necessary for that person to give consent, I agree to hold such person free and harmless of any liability for damages arising from giving such consent. I declare that my child is covered by medical insurance and/or that I am responsible for any and all expenses incurred by my child whether covered under insurance or not. I have read and understand this Medical Release and Consent Form and represent that all of the information contained herein is true and correct. I, hereby, accept and assume all the risks of injury associated with the activities of Moody Memorial FUMC Ministries. Unless terminated in writing, this release shall be effective for one (1) year. Custodial Parent or Legal Guardian Signature: Date: STATE OF TEXAS COUNTY OF Galveston This instrument was acknowledged before me on, 201 by. Notary Public, State of Texas Media Release I permit Moody Memorial First United Methodist Church (MMFUMC) to photograph, record, and/or publish information sounds and images of my child while participating in activities with the church. I permit MMFUMC to publish these images or sounds through any medium they choose, including, but not limited to, print, video tape, DVD, Social Media, and/or the Internet. Those items placed on the internet will be exclusive to either the youth or the church websites. Any other use of the material will be deemed appropriate by the Student Ministry staff. Parent s (printed) Name: Child s Name Signed Date
Big House 2015 Scholarship Application At Moody Memorial FUMC we don t want a lack of funds to keep you from attending an event. We are happy to arrange a payment plan or work out a scholarship of some sort for you. Please complete the following information to help us understand how we can best help you. We are limited on funds that we have to offer, so make sure that you get this turned in as soon as possible. All information is confidential and we will make every effort to help. Please turn this in with your other forms. Thanks! Payment Plan Date Amount By completing this section of the form, you are able to pay for the trip, but need to do it in smaller amounts. In the box, please list the dates you are able to pay and the amount you can pay. You are free to take as long as you need, we just need to know when to expect the payments. Scholarship $50.00 deposit By completing this section, you are expressing a need for a partial scholarship. In order to receive a partial scholarship, we will need some commitment on your part to help with various events at the church. Amount of Scholarship Needed: $ (Full amount you can request is $62.50) Activities: Serve at Pancake Supper Attending 30 Hour Famine Will serve communion on Easter Helped at Tacky Prom Willing to come up to the church to help Heather, Emily or Terri. Worked in the pumpkin patch Serving in other ministries: Student Name: Parent Signature_