Impact Youth Summer Camp

Where: Menucha Retreat Center Corbett, Oregon

When: We will Gather at the church at 11:30am on Saturday the 19th of July, return Tuesday the 22nd of July around 2pm. Please see Pastor Jason Kelley for a list of items to bring with you on this trip.

What: Youth Summer Camp is for youth in 5th-12th grade. You are encouraged to bring your friends, just make sure they turn in a copy of the parental permission form on the back of this flyer.

Theme: “Dig-in” by Ron Luce, taught by Pastor Jason and Michelle Kelley

Cost: $150 per person. Do NOT stay behind because of cost. There are scholarships. Deposit and form due by May 11th. Pay online by clicking the button below, or write a check to The Refuge with your student’s name in the memo.

Pay Here

Student's Name

First Name

Last Name

Parent's Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

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Emergency Contact Name

Emergency Contact #

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Allergies or current medications?

Any prescriptions should be made known to the Retreat Medical Person: Michelle L. Kelley, MSN FNP. Please also share instructions for medication.

Our group will gather at the church at 11:30am on the 19th. Are you are able to go early with Michelle Kelley, Pastor Jason’s wife? (9am) to help Michelle set up and get ready for the weekend?

Is there another student you'd like to lodge with?

I certify that my son/daughter has no injury that would limit his/her participation in this Camp. I, by my signature below, do hereby delegate to the staff of Menucha Retreat Center and The Refuge, the authority to seek, obtain, and approve any medical care and treatment for the above named camper, which in their judgment is necessary for the health and well being of my child in the event I can not be reached. Further, I agree not to hold the Menucha Retreat Center, The Refuge, and their employees for any liability arising out of any good faith actions taken in seeking and obtaining medical care and treatment for the above named student. I understand every effort will be made to contact me before such action is taken. All costs incurred are the responsibility of the parent/guardian.

If you have any Questions, please contact:

Pastor and Camp Director Jason Kelley (706) 372-2066

Camp Medical Person: Michelle L. Kelley (507) 399-1422

*Note: Please make sure you are at the church no later than 11:30am on July 19th.