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About
Our Vision and Values
Statement of Faith
Our Leadership
Missions
DMI Mission and Vision
Mission locations
Long-Term Service Opportunities
Missions Festival
Missions Internship
Short-Term Teams
DMI Golf Tournament
Missions Giving
Contact DMI
Ministries
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Fivefold Ministers
International Locations
Partnering
Church Planting
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DOVE Youth Winter Retreat
Youth Missions
DOVE Global Leadership & Ministry School
DOVE Mission International
Church Planting
Events
Resources
Free Resources
Video & Audio Resources
Ron Myer’s Blog
Church Plant USA Blog
Invite a Recognized Five Fold Minister
Larry Kreider’s Blog
Steve Prokopchak’s Blog
Brian Sauder’s Blog
Online Book Store
DOVE Global Leadership & Ministry School
Contact
GIVE
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DOVE USA Youth Winter Retreat Registration
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DOVE USA Youth Winter Retreat Registration
DOVE USA Youth Winter Retreat Registration
STRYV Creative
2020-10-16T13:40:25-04:00
Please complete the following form to register for Winter Retreat 2021. Thank you!
Please acknowledge the following before beginning:
*
Got it!
Date of Retreat: March 12-14, 2021
Location: Refreshing Mountain Camp
Cost: $130* - includes lodging, food, and a cool t-shirt 🙂
Arrival is between 6:30-7pm on Friday, March 12th. Activities begin at 7:30pm.
*Payment will be made separately from this application on a due date specified by your local youth leader.
I will be attending Winter Retreat as a _________ .
*
Student
Youth Leader / Volunteer
Personal Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
CĂ´te d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ă…land Islands
Country
Gender
*
Male
Female
Home Church:
*
T-Shirt Size:
*
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Youth Leader/Volunteer Information
Email
*
Mobile Phone
*
Is there anything that you have dealt with in your history that we ought be aware of that would inhibit your ability to lead youth effectively?
*
Youth Leader/Volunteer Agreement
*
I agree to be a living example of Jesus to the youth of Winter Retreat.
As a leader at Winter Retreat, you will expected to set the tone and lead by example throughout the weekend. This means that you commit to living above reproach, with high character, and integrity in all areas of life. Making it a priority to love God and love others with all of your heart. Looking to Jesus Christ as the model of conduct for the entirety of your time serving at Winter Retreat. If you cannot uphold this commitment, we request that you not serve at the retreat.
Youth Leader/Volunteer Signature
*
Student Information
Birth Date:
*
Date Format: MM slash DD slash YYYY
Age at time of retreat:
*
Winter Retreat has been designed for students age 13-18. Please e-mail
*protected email*
before continuing if you do not fall within this age range.
Applicant Email (if they have one)
Parent Name 1:
*
First
Last
Parent Name 2:
First
Last
Parent Phone (Primary)
*
Parent Phone (Back Up)
Parent E-mail:
*
Youth Leader Information
Youth Leader(s) Name
*
First
Last
If you do not have a youth leader, please place 'N/A' in this field. Thank you.
Youth Leader(s) Email
*
Please use the primary e-mail your youth leader uses to contact you. If you do not have a youth leader, please place '
*protected email*
' in this field.
Medical/Insurance Information
Name of Insurance Carrier:
*
Member Name
*
First
Last
Policy #:
*
Physician Phone #
What medical or physical limitation should we be aware of that may affect your participating in any activity? (This information will be kept confidential)
Do you currently take any medications? (If yes, please list the medications and condition being treated)
Parental Consent
If you are under 18 years, your parent or guardian must complete the following:
Consent to Attend
*
My child has my permission to attend the DOVE USA Youth Winter Retreat at Refreshing Mountain Camp in Lancaster, PA.
Medical Consent
*
I agree to the following statement.
I consent to emergency medical treatment deemed necessary in the unlikely event of an accident. I will pay for any and all expenses incurred should insurance not cover them. I also release DOVE USA, the host ministry and staff from any liability resulting from any accident or illness. I will take full financial responsibility for costs incurred if my child needs to be sent home due to an emergency or misbehavior.
Parental Release and Indemnification Agreement
*
I agree to the following statement.
DOVE USA, a Pennsylvania nonprofit organization with offices at 11 Toll Gate Road, Lititz, PA 17543 runs Winter Retreat in accordance with policies and values of DOVE USA.
We, the undersigned parent(s) or legal guardian(s) execute this Parental Release and Indemnification Agreement (Agreement) for and on behalf of the application-identified Child. We affirm that we hold legal status of parent or legal guardian of the Child. We understand that for the Child to participate in Winter Retreat, all parents and legal guardians of the Child shall execute the Agreement.
We agree that the Child will abide by the policies established by DOVE USA, and as enforced by DOVE USA in its sole discretion.
Both for ourselves and on behalf of the Child, we hereby assume the risk of activities that we or the Child engages in with Winter Retreat including risks encountered in sports activities and transportation for such activities. We hereby release, discharge, and/or otherwise indemnify DOVE USA and affiliated sponsors and organizations, their employees, volunteers and associated personnel [including the owners of property and facilities utilized for the program], from and against any claim, loss or damages by or on behalf of us or the Child arising from the negligence of any DOVE personnel (including volunteers) or from our or the child’s participation in Winter Retreat activities or transportation.
We agree that to the extent we or the Child’s other parent(s) or legal guardian(s) is liable for any claim involving DOVE USA that we shall be held jointly and severally liable, together with the Child’s other parent(s) and legal guardian(s), for any liability arising from the Child’s participation in Winter Retreat activities or transportation.
We agree to assume full responsibility for any medical bills incurred, in the event any health insurance we have or do not have would fail to cover the full cost of treatment, transport, or other emergency service incurred for the Child. Should DOVE USA in its sole discretion determine that the Child must return home before the group for medical or disciplinary reasons, we hereby agree to assume any costs for such travel, including costs for meals and accommodations.
Parent/Guardian Signature:
*
By signing I affirm that I am the parent or guardian of the applicant and consent to each of the above statements.
Student Consent
The student applicant should complete this section of the application.
Acknowledgment of Cost : $130/person
*
I understand that I will be expected to either fundraise or pay the full amount of Winter Retreat to my youth leader prior to attending Winter Retreat on the date that my youth leader elects. I am responsible for the cost, not my parents. If my parents choose to pay for me to attend, it is out of the graciousness of their heart and I will give them a big hug. Please make checks payable to 'your church'. Do not make payment directly to 'DOVE USA' unless specified. Thank you.
Student Consent for Dismissal or Disciplinary Action
*
I understand and agree with the following statement.
Doing any of the following is grounds for dismissal from Winter Retreat:
1. Using alcoholic beverages, illegal drugs, or tobacco of any kind
2. Stealing or gambling
3. Pornography
4. Displaying any level of romantic or dating relationships - this includes holding hands, kissing, etc.
5. Going outside of the team housing area alone.
Doing any of the following is grounds for disciplinary action and possible dismissal from Winter Retreat:
1. Fighting, disorderly conduct, or excessive noise
2. Using profanity or temperamental outbursts
3. Listening to vulgar music or reading inappropriate material on your phone
4. Two individuals of the opposite sex alone
5. Not keeping your bed and items neat and clean
6. Disobedience to team leaders
7. Not keeping curfew
Student Signature
*
By signing above I agree to the guidelines and rules of Winter Retreat. I also commit to living pure and staying positive throughout the event. I understand that this weekend has been designed to transform my life and I plan to give everything I have to loving God and loving those around me.
Section Break
Email
This field is for validation purposes and should be left unchanged.