Parents and Students,

Middle School retreat season is here and we are excited for what God has planned for us this year!
This month, the 8th grade will be going to InterVarsitys Campus by the Sea on Catalina Island. We
depart at 7:45 am on Wednesday, October 21st and will return by 12:30 pm on Friday, October 23rd.
Please review the documents in this packet. Several will need to be signed and returned.
Please return the following documents to Mrs. Mirich in the MS office by Wednesday,
October 7th:

Code of Conduct
SFCS Activity Parental Permission
Emergency Contact/ Medical Release Form
Overnight Medication Authorization Form (for students required to take or carry medication)
Release of Liability (Campus by the Sea)

Sincerely,
Mrs. Joanna Burkholder
8th Grade Retreat Director - mailto:jburkholder@sfcs.net (questions)
Other contacts:
MS Office- mailto:emirich@sfcs.net (forms) (858) 755-8900 x1026
InterVarsity Campus by the Sea - 1 Gallagher's Cove, Avalon, CA 90704 (310) 510-0015
Nurse - Sandy DeWoody mailto:sdewoody@sfcs.net (858) 755-8900 x 1010

Please keep this page for your reference and return all other documents to Mrs. Mirich.

8th Grade Retreat Fact Sheet

DATES & TIMES:
Wednesday 10/21, students drop off luggage in front of gym
Students LOAD buses at 7:45 am in front of the gym on Wednesday 10/21
Pick up Friday 10/23, 12:30 pm in front of gym (students waiting for the bus will meet in the chapel until 1:45 pm)
THINGS TO KNOW:
School electronic policy is in place for retreat. Students may bring phones to communicate designated times, but phones used without permission
or inappropriately will be taken away and picked up MONDAY morning following retreat in the MS office. There is also no cell phone service at all at
the camp, so cell phones are not able to used.

NO extra food/snacks/candy Why? Live animals!!! You do not want critters and ants! (If you have special dietary needs, please coordinate with Mrs.
Burkholder in advance at mailto:jburkholder@sfcs.net)

PACKING: Only ONE reasonably-sized piece of luggage and a warm sleeping bag. We will enjoy a simple lifestyle at camp, so please pack light.
** You will be carrying your own luggage up a dirt hill to the camp once we arrive. Be smart about packing. **
A warm sleeping bag & pillow (mattresses are provided)
Clothing: shorts, t-shirts, pants/sweats for the evening, water-resistant jacket, warm jacket and/or sweatshirt.
Dress code approved swim suit
Towel
Toiletries
Shoes: athletic shoes AND sandals for beach/showers
Water shoes: the beach is VERY rocky (optional)
Fun TEAM COLOR items to represent your team colors (will be announced week before camp)
Flashlight
Bible, pen/pencil
Hats (if desired)
Money for snack shop
Watch (cell phone service is non-existent)
Bug repellant
WATER BOTTLE
RETREAT DRESS CODE:
Everyone:
Personal hygiene is important
Shoes or sandals must be worn at all times
No clothing advertising tobacco, alcoholic beverages, violence, weapons, profanity or inappropriate, obscene or suggestive slogans should
be worn.
Ladies:

Shorts/skirt length: Shorts must be mid-thigh in length. A good rule of thumb is the length reaches the index finger of student when arms
are held straight by side
Tank tops: shoulder straps must be at least two fingers in width; bra straps may not show
All shirts: must not reveal stomach when hands are listed above head
Yoga pants: shirt must reach index finger of student when arms are held straight by their side (same applies for tight-fitting pants,
jeggings, etc.)
Swimwear: wear a modest one-piece or tankini that covers cleavage, stomach, and bottom. All suits should have shoulder straps. A dark
rash guard/T-shirt and board shorts over a bikini provide additional coverage and ensure modesty.

Fellas:

No underwear showing. If you need a belt, get one!

Shirts: Keep your shirt on at all times in public areas
Swimwear: no Speedos or swim briefs
Boys are expected to remove their hats during times of worship and prayer.

CODE OF CONDUCT AGREEMENT

Parents and Students,
There are some non-negotiable standards that must be understood by students to protect the purpose and
vision for our time together.
We expect that each student will:

Treat the facility with respect. Vandalism in any form will not be tolerated. Leave the camp
cleaner than when we arrived. Bathrooms, rooms, the dining hall, field, and meeting hall need to
remain clean at all times.

Treat one another with respect. This means no hazing, pranks, taking someone elses property
without permission, or doing anything demeaning to another student. We want to treat all of our
peers with dignity and respect.

Demonstrate a positive attitude toward the speaker and their teachers at all times.
Include others as opposed to exclude others.

Remain in their dorms for the remainder of the night at the designated curfew time.
After hours sneaking out will not be considered a joke. For safety and other reasons, this policy
must and will be enforced.

These non-negotiable standards should help our retreat to be fun and memorable. Should students choose
to violate any of these standards; parents will be called to pick up their student from the camp immediately.
Other additional consequences may be rendered at the appropriate time. Please support us in our effort to
have a Christ-centered, fun retreat.
Sincerely,
Mrs. Joanna Burkholder
8th Grade Retreat Director

Code of Conduct Agreement:

I have read the above Code of Conduct and understand that any form of vandalism, hazing,
breaking camp rules, etc. will not be tolerated and may result in expulsion from the retreat.
Student Signature:_____________________________________Date_____________
Parent Signature:_____________________________________Date_____________

Academic Year 2015-2016

PARENTAL PERMISSION FOR ANY SCHOOL-RELATED ACTIVITY

Students Name (print) __________________________________________________

Baseball
Basketball
Cheerleading
Cross Country
Football
Water Polo
Music

Soccer
Softball
Tennis
Track
Volleyball
*Other
*Field Trip

*Staff: Please complete this portion for Other and Field Trip Only*
Purpose of Field Trip: Retreat
Teacher/Class: 8th Grade
Destination: InterVarsity's Campus by the Sea
Date & Time of Departure from SFC: Wed. Oct. 21st, 7:45 a.m. Time of Return to SFC: Friday, Oct. 23rd, 12:30 p.m.
Dear Parent: Your signature below indicates permission for your child to participate in the above-mentioned activity.
PARENTAL AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR
Herein Parent (print)
Herein Student (print)
The above-named Parent/Legal Guardian of the Minor has entrusted, for a temporary period of time, the Minor into the care of
Santa Fe Christian Schools and its Agent, an adult, for particular reasons and for the welfare of the minor. The Parent does
hereby authorize the Agent, as agent for the undersigned to consent to any X-ray examination, anesthetic, emergency Paramedic
treatment, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered
under the general or special supervision of, any physician, surgeon, or paramedic licensed under the provisions of the Medical
Practice Act on the medical staff of any hospital; or to consent to any X-ray examination, anesthetic, dental or surgical diagnosis
or treatment to be rendered to the Minor by any dentist licensed under the provisions of the Dental Practice Act. It is understood
that this authorization is given in advance of an X-ray examination, anesthetic, medical or surgical diagnosis or treatment and
hospital care being required but is given to provide authority and power on the part of the Agent to give specific consent to any
and all such examination, anesthetic, diagnosis, treatment or hospital care which the aforementioned surgeon, physician and/or
dentist, in the exercise of his/her best judgment, may deem advisable. Agent will make a good faith effort to contact Parent in
advance of any treatment being rendered, but this consent is unequivocal and advance. Parents consent is not conditioned
upon Agent reaching Parent prior to treatment being rendered as contemplated in this paragraph.
This authorization is given pursuant to the provisions of Section 6910 of the Civil Code of California. The Parent hereby authorizes
any hospital which has provided treatment to the Minor pursuant to the provisions of Section 6910 of the Civil Code of California
to surrender physical custody of the Minor to the Agent upon the completion of treatment. This authorization is given pursuant
to Section 1283 or the Health and Safety code of California.
These authorizations and permission to participate shall remain effective until revoked in writing delivered to said Agent.
Parent Name (Print):

Date:

Signature:
Parent Phone Number: Home: __________________ Cell: ______________________________ Work: _______________________

Emergency Contact/Medical Information Form

Contact Information

Student Name

Grade

Father's Name

Mother's Name

Home Number

Home Number

Father's Cell Number

Mother's Cell Number

Father's Work Number

Mother's Work Number

Emergency Contact Information (In addition to father/mother listed above; contacted only if unable to reach parents).

Emergency Contact #1

Emergency Contact #2

First, Last Name

First, Last Name

Relationship

Relationship

Contact Number

Contact Number

Medical Information
Doctor Name

Doctor Phone

Dentist Name

Dentist Phone

OK for nurse to administer Tylenol? Yes

No

Does your child have a life-threatening health condition? Yes

No
(If so, please describe. Use the back side of this form as necessary.)

Medical Conditions/Allergies (explain as needed)

Asthma

Food Allergies

Diabetes-Insulin Dependent

Medication Allergies

Hearing Problems

Other Allergies

Heart Problems

Other serious health problems

Seizure Disorders

Medications taken regularly

Insurance Information:
Insurance Company

Insurance Group/Policy #
5

OVERNIGHT MEDICATION AUTHORIZATION FORM

Dear Parents:
The SFCS overnight school activity to InterVarsity's Campus by the Sea is scheduled on Oct. 21st- 23rd, 2015. To ensure your
childs health, safety, and well-being while they are away from home, basic first aid will be provided by SFCS staff and parent
volunteers attending the activity.
If your child will require medication during this activity, please complete and sign the authorization below. This authorization is for
all medications including over-the-counter medications, homeopathic medications, or dietary supplements. All medication must be
sent in the original container and should be placed it in a zip lock bag along with this signed consent (exception inhalers
see below). No medication will be administered to your child without prior written authorization from you (EC494423). In
compliance with state regulations, students are not allowed to carry or take medications on their own during the school day
including overnight school activities with the exception of Epi-pens, asthma inhalers and insulin. If your child will require
an inhaler during this activity, please place the signed consent in a zip lock bag and have your child keep their inhaler
with them.
Please note: All prescription medication will require written authorization from your childs physician.
All medication will be collected by SFCS staff prior to departure for this overnight activity.
If you have any questions or concerns, please contact me at (858) 755-8900 extension 1010 or sdewoody@sfcs.net.
In His Service,
Sandy DeWoody, R.N.
------------------------------------------------------------------------------------------------------------------------------I give permission to Santa Fe Christian School to administer medication to my child during the SFCS overnight school activity. All
medication will be administered by SFCS staff or trained volunteers.
Student Name:______________________________________
I give permission for my child to be given Tylenol or Advil Yes No
I give permission for my child to be given Cough drops and/or Tums Yes No
________________________________________________________________________________________
(Name of Medication) (Method of Administration) (Dosage) (Times to be given) (Reason for Medication)
________________________________________________________________________________________
(Name of Medication) (Method of Administration) (Dosage) (Times to be given) (Reason for Medication)
_____________________________________________________________________
(Parent Signature)
(Date)