Young Scout Retreat Flyer and Registration Form Jan 2014
LEAD ME, LORD
Saturday January 25, 2014 St. Raymond’s 8750 Pohick Road Springfield, VA 22153
The Young Scout Retreat is an opportunity for youth in Cub Scouts, Girl Scouts, American Heritage, & Camp Fire, grades K –5th to participate in activities designed to stimulate and encourage their Catholic faith through service. The cost is $12.00 per scout. To register, mail form and payment to: Becky Chaves, YSR Coordinator 8617 Meadow Edge Terrace Fairfax Station, VA 22039
Registration Deadline: December 28th Please e-mail [email protected] with any questions.
YOUNG SCOUT RETREAT
The Arlington Diocese Catholic Committee on Scouting PRESENTS...
Agenda: 9 am: attend Holy Mass with Parent 9:45—10 am: Check-in at Parish Hall 10:10 am: Opening Flag Ceremony 10:15 am—2:25 pm: Prayer, Games, Songs, Crafts, Lunch and Activities 2:30 pm: Closing Flag 2:45 pm: Dismissal Be sure to bring a bag lunch!
Arlington Diocese Young Scout Retreat Registration and Permission Form Saturday, January 25, 2014, 9:00 a.m. to 2:45 p.m. at St. Raymond's Parents/Guardian: Address: Phone Number:
Cell Phone Number:
E-Mail Address: PARTICIPANT(S) INFORMATION: Scout(s) Attending:
Grade: (must be K5)
Program Level: (Daisy, Brownie, Tiger, Webelo, etc.)
Pack, Unit, or Troop Number:
1) 2) 3) Emergency Contact Information: (please list an alternate contact if adult listed above can't be reached) Name:
Relationship to Scout:
Phone Number:
Cell Phone Number:
Health Information: (indicate which child/ren if registering more than one scout in your family) Allergies: Physician Name: Health Conditions that Affect Participation in Retreat:
Permission: 1) My child/children listed above has/have my permission to participate in all activities associated with the Diocese of Arlington Young Scout Retreat on January 25, 2014 at St. Raymond's Church, Springfield. In the case of injury or illness, the adult advisors of the Young Scout Retreat (YSR) are authorized to render emergency first aid and/or seek all necessary medical attention. In such cases, I understand that I will be notified as soon as possible. I agree to hold harmless and blameless the leadership of the Young Scout Retreat (including any additional adults participating in or providing assistance to any activity associated with the YSR), St. Raymond's Church, CCOS, the Diocese of Arlington, the BSA/National Capital Area Council, Camp Fire USA, American Heritage Girls or GSUSA/GSCNC from any injury or illness resulting from my child/ren’s participation in the YSR. I have noted any medical or other special consideration above; if my child has any serious illness, injury, or medical treatment before the YSR of which the adult advisors should be aware, I will provide the information to the YSR Coordinator prior to the retreat. 2) I have included the $12 payment required for participation in the retreat. Checks should be made payable to CCOS.
(Signature of Parent or Guardian)
(Date)
This form and and payment must be received no later than December 28, 2013. Registration is limited. Please mail to: Becky Chaves, Attention: Young Scout Retreat, 8617 Meadow Edge Terrace, Fairfax Station, VA 22039
For further information or questions, please call (703) 425-4965 or e-mail [email protected].
Saturday January 25, 2014 St. Raymond’s 8750 Pohick Road Springfield, VA 22153
The Young Scout Retreat is an opportunity for youth in Cub Scouts, Girl Scouts, American Heritage, & Camp Fire, grades K –5th to participate in activities designed to stimulate and encourage their Catholic faith through service. The cost is $12.00 per scout. To register, mail form and payment to: Becky Chaves, YSR Coordinator 8617 Meadow Edge Terrace Fairfax Station, VA 22039
Registration Deadline: December 28th Please e-mail [email protected] with any questions.
YOUNG SCOUT RETREAT
The Arlington Diocese Catholic Committee on Scouting PRESENTS...
Agenda: 9 am: attend Holy Mass with Parent 9:45—10 am: Check-in at Parish Hall 10:10 am: Opening Flag Ceremony 10:15 am—2:25 pm: Prayer, Games, Songs, Crafts, Lunch and Activities 2:30 pm: Closing Flag 2:45 pm: Dismissal Be sure to bring a bag lunch!
Arlington Diocese Young Scout Retreat Registration and Permission Form Saturday, January 25, 2014, 9:00 a.m. to 2:45 p.m. at St. Raymond's Parents/Guardian: Address: Phone Number:
Cell Phone Number:
E-Mail Address: PARTICIPANT(S) INFORMATION: Scout(s) Attending:
Grade: (must be K5)
Program Level: (Daisy, Brownie, Tiger, Webelo, etc.)
Pack, Unit, or Troop Number:
1) 2) 3) Emergency Contact Information: (please list an alternate contact if adult listed above can't be reached) Name:
Relationship to Scout:
Phone Number:
Cell Phone Number:
Health Information: (indicate which child/ren if registering more than one scout in your family) Allergies: Physician Name: Health Conditions that Affect Participation in Retreat:
Permission: 1) My child/children listed above has/have my permission to participate in all activities associated with the Diocese of Arlington Young Scout Retreat on January 25, 2014 at St. Raymond's Church, Springfield. In the case of injury or illness, the adult advisors of the Young Scout Retreat (YSR) are authorized to render emergency first aid and/or seek all necessary medical attention. In such cases, I understand that I will be notified as soon as possible. I agree to hold harmless and blameless the leadership of the Young Scout Retreat (including any additional adults participating in or providing assistance to any activity associated with the YSR), St. Raymond's Church, CCOS, the Diocese of Arlington, the BSA/National Capital Area Council, Camp Fire USA, American Heritage Girls or GSUSA/GSCNC from any injury or illness resulting from my child/ren’s participation in the YSR. I have noted any medical or other special consideration above; if my child has any serious illness, injury, or medical treatment before the YSR of which the adult advisors should be aware, I will provide the information to the YSR Coordinator prior to the retreat. 2) I have included the $12 payment required for participation in the retreat. Checks should be made payable to CCOS.
(Signature of Parent or Guardian)
(Date)
This form and and payment must be received no later than December 28, 2013. Registration is limited. Please mail to: Becky Chaves, Attention: Young Scout Retreat, 8617 Meadow Edge Terrace, Fairfax Station, VA 22039
For further information or questions, please call (703) 425-4965 or e-mail [email protected].
