Formosan Presbyterian Church

in Greater Houston
2401 S. Dairy Ashford · Houston · TX 77077
www.fpcinhouston.org
(281) 589-9795
(832) 722-8447

2008 FPC EM Retreat at Trinity Pines

August 8 - August 10, 2008
*** Please turn in all forms by July 20th, 2008 ***

Students Name ____________________________ Age _______ Grade _______

Address _______________________ City _____________________ Zip ________

Parent’s/Guardians Name ____________________________ Date ____________

Home Phone # ____________________ Work Phone # _______________________

Shirt Size ____________ E-Mail ___________________________________

Parental Consent and Certification

I/We, ___________________________ the father and mother (or legal guardian) presently having the sole care and
custody of a minor, on behalf of him/her and his/hers heirs, personal representatives, and assigns, for and in
consideration of its agreement to accept such minor into the following program 2008 FPC EM
RETREAT, 8/08/08-8/10/08 and to provide such minor with an educational experience which cannot be
experienced in its facilities, hereby fully release and discharge Formosan Presbyterian Church, its representatives,
successors, and assigns, from all rights, claims, and actions of every kind which such minor may have against such
released party arising out of 2008 FPC EM RETREAT, 8/08/08-8/10/08
We further release Formosan Presbyterian Church from, and fully waive, any and all rights we may have, for any reimbursement for medical and
other expenses incurred because of any injury to such a minor.

As the parent (or legal guardian), I certify that I have been informed of and authorize my child to participate
in 2008 FPC EM RETREAT, 8/08/08-8/10/08. I understand as with most activities there is a certain degree of
risk. Some of these activities may include: all activities associated with Formosan Presbyterian Church. I consent
for my child to participate in these activities. I also represent that my child is physically fit and has necessary skills
to safely participate in these activities.

It is my understanding that the church will attempt to notify me in case of a medical emergency involving my child. If the church cannot reach
me, then I authorize the church to hire a doctor or other health-care professional, and I give my permission to the doctor or other health-care
professional to provide the medical service he or she may deem necessary. I will pay for any medical expenses so incurred. I will notify the
Church if I feel there are any health considerations or other information that would prevent my child’s participation in any of the activities listed
above. I also give my permission for church youth leaders to restrict my child from participation in any activity which they have any question
about for health or other reasons.

Contract #____________________________ Group # _________________________

Insurance Name________________________ Insurance Phone #___________________

Print Name and relationship _______________________ Signature _______________________

 *** Please attach any medical conditions, medications, and diets we need to be aware of ***
Formosan Presbyterian Church
in Greater Houston
2401 S. Dairy Ashford · Houston · TX 77077
www.fpcinhouston.org
(281) 589-9795
(832) 722-8447

*** KEEP THIS PAGE FOR YOUR OWN REFERENCE ***

Where: Trinity Pines, Trinity, TX (Van-Pool from and to will be provided. more details as we get closer)
Driving Directions:
FROM HOUSTON VIA I-45: Take exit #113 as you approach Huntsville. This feeds into Hwy 19 north.
Travel 20+ miles into Trinity and turn right at the second light onto Hwy 94. Go only 1/4 mile and turn
right at blinking yellow light onto Hwy 356. Trinity Pines is 4+ miles down on the left.

FROM HOUSTON VIA HWY 59: Travel to Livingston and exit Hwy 190 west and travel 15 miles to
Onalaska. At light in Onalaska turn right on Hwy 356 and travel 14+ miles. Trinity Pines is on the right just
past YMCA Camp Cullen.

More info at www.trinitypines.org

When: Fri., August 8 – Sun. August 10, 2008 (arrive around 6pm. Please provide your own dinner for Friday night)

What: Formosan Presbyterian Church EM Retreat

Cost: $40. Please make all checks payable to Formosan Presbyterian Church
(If necessary, Financial Aid is available)

Why: ‘Cause praising GOD and having FUN is what this is all about!!! =)

Rules to follow:

1. The 10 Commandments always apply.

2. Bibles!!!
3. Bring your own toiletries (toothbrush, toothpaste, soap, shampoo, etc)
4. NO electronic entertainment devices. This includes but are not limited to
a. Portable Game Consoles
b. MP3 Players, etc.
c. Anything that will make you anti-social (electronic group games are fine)
5. Swimwear:
a. Guys – NO SPEEDO
b. Girls – ONE PIECE PLEASE (if you cannot, wear a shirt over if you are planning to swim)
6. Absolutely no purpling ( no Guys in Girl’s sleeping area and vise versa)
7. Bring clothes that you can get dirty on. Don’t bring anything fancy, you don’t need it!
8. Other Rules may be added as necessary

If there are any additional questions or concerns, please do not hesitate to contact the church or myself at:

Guillermo Yang
281-650-9991 (c)

As God’s Covenant Family, we diligently study the Bible

and seek to practice the Lord’s teachings. [主內一家：勤讀聖經、勵行主訓.]
Psalm 100:3—Know that the LORD, he is God!
It is he who made us, and we are his; we are his people…