High School Leadership Registration Form

Dates: Monday, December 30th to Thursday, January 2nd

Location: Camp Mozumdar 865 Mozumdar Dr. Crestline, CA 92325

For who: Current High Schoolers

WHAT is this winter workshop all about? Our theme will be:

JESUS & ME

Price: $75 for Leaders

Transportation

Please drop off at Camp Mozumdar - no carpool organized
Flying in? --> If you are flying you will have to coordinate your own ride to camp
Bay Area only - carpool with young adult leaders and parent drivers organized by Joseph a'Beckett

NOTE: After Winter Workshop there is Peace Cup from Jan 2nd to Jan 5th. You can find the necessary information and registration here: https://www.peacecupla.org/

Bay Area Logistics Coordinator: Joseph a'Beckett

Questions or concerns contact Sarah Takhar, Winter Workshop Director

[email protected]

Group Leaders Information

Name

Gender

Male
Female

Date of Birth

Age

Church Community Name and State

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Registration Options

Group Leader ($75.00)

Medical Info

Any health conditions that we need to be aware of? Any allergies?

Any prescription medication required on this trip? Name of Medication(s):

Any restriction of activity for medical reasons?

MEDICAL INSURANCE INFORMATION (Name of insurance, medical number, group number):

Medical Consent

Please read and sign

I certify that my answers are true and complete to the best of my knowledge. In the event I cannot be reached in an emergency, I give permission to workshop adult staff to administer over-the-counter medicine as needed and the physician and hospital selected by the adult leader in charge to give whatever medical aid is necessary. In consideration of the activity staff and organization for the effort to provide the children with a nurturing and enriching experience, I hereby agree to assume complete responsibility for any costs, medical or other, incurred by my child while attending this event. I am aware we just came back from a pandemic and that I could be exposed to the flu, covid, a cold, other health symptoms. I will not legally implicate the event staff, Family Federation (FFWPU-USA), or the facility owner or manager.

I, the undersigned, agree to the terms above.

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship with Participant(s)

Why be a group leader?

Why do you want to staff for Winter Workshop?

We are all growing in our faith and relationship with God. How is your relationship with God and how are you working on growing in your faith/relationship with God?

What kind of experience do you want the participants of the camp to have? What can you do to help provide that experience to the participants?

What kind of culture do you want to promote at Camp?

What does it mean to be a group leader to you?

Winter Peace Cup 2025

NOTE: After Winter Workshop there is Peace Cup from Jan 2nd to Jan 5th. You can find the necessary information and registration here: https://www.peacecupla.org/

Are you planning to attend Peace Cup?

Payment

Cash and checks are preferred. All payment should be completed prior to the deadlines (see beginning of form).

Make a check payable to "HSA-UWC", and mail it to Los Angeles Family Church, Attn: Winter Workshop 2024, 2301 Findlay Ave, Monterey Park, CA 91754

After ___, cancelations will be refunded by half and not full amount.

Payment Method

Online
Cash prior to camp
(This is only for those locally in the Los Angeles who can directly give it to the LAFC Bookkeeper or Sarah Takhar)
Check mailed to LAFC

Scholarship Code

Total

$75.00

Code of Conduct Agreement

Leadership Code of Conduct

As a staff in the Cali Winter Workshop, I will do my best to observe all the following conditions and requirements:

1. I will not smoke, drink alcoholic beverages, or take illegal drugs, or have any of these items in my possession. This behavior is grounds for immediate and unconditional expulsion from the workshop.

2. I will not deface any property or site, nor will I support or conceal such actions of others. I understand that I will be asked to leave the workshop immediately if I behave in this manner.

3. I will not engage the promiscuous or flirtatious behavior and I will dress according to the workshop dress code standards.

4. I will fully participate in all programs and activities unless the workshop nurse indicates that I am too injured or sick to participate.

5. I will respect and support all workshop site rules and regulations and encourage others to do the same.

6. I will respect and support all people at the workshop site and I will not engage in or support any activity that may put others in physical, emotional, or spiritual danger.

7. I will make every effort to conduct myself in a dignified manner befitting a son or daughter of God.

We have a zero tolerance policy for drugs, alcohol, and sexual contact. The camp staff has the authority to search any participant’s belongings if drugs, alcohol, etc. are suspected. If drugs are found, the drugs will be confiscated and the participant will be sent home immediately at the parents’ expense.

Please read this Code of Conduct to acknowledge your acceptance of, and willingness to adhere to the above-mentioned standards. If for any reason you ask to leave the workshop, you/your family will be required to pay any costs incurred in your return home. The core staff will go over all of the above points at the camp orientation.