Gather….Grow….Go….Spread the Good News!
And remember, I am with you always, to the end of the age. -Matthew 28:20b What does this mean? When Martin Luther crafted the Small Catechism, his objective was to help people of all ages to better understand many of the basic tenants of our Christian faith (The 10 Commandments, The Apostles’ Creed, The Lord’s Prayer, etc.). Throughout the Small Catechism, as Luther explained various top- ics of importance, he frequently included the question: What does this mean?. Luther’s logic for doing so was simple. If one knows the 10 Commandments but does not know what value they hold for them personally or otherwise, well, that does not do anyone any good. But, by repeatedly asking what does this mean, Luther emphasizes the need to reflect on the importance behind these tenants of the faith. Whether because of Luther’s influence, or the hundreds of years of using the Small Catechism, Lutherans have a history of asking this reflective question in all walks of life. Whether studying scripture or living our lives out in the world, we ponder, wonder, and search for meaning. With my pending departure, I know a lot of people are wondering what does this transition mean for them, for our congregation, for our community, for the Beerys…for all sorts of people and situations. I can’t hope to answer all these questions, but I will try to touch upon some of them. And while some of the responses may seem obvious, they still need to be stated. What does this transition mean for…Messiah?: • It means there will be new pastoral leadership for our congregation. This will happen first in the form of
interim ministry where a pastor will be in place to serve the congregation in more of a temporary basis. The interim pastor’s service could be a year in length, or it could only be a couple of months before another interim replaces him/her. Your next called pastor will likely not begin until at least a year from now. Mes- siah’s Church Council will keep you up-to-speed on this process as there are lots of steps involved in call- ing a new pastor.
• It means there is an opportunity to reflect on what has been going well, what areas of ministry need atten- tion, and what do you hope for in your new pastor. Again, the Church Council will lead you in this inten- tional reflection and you will have opportunities to share your concerns and dreams with them.
• It means it’s imperative for you to keep doing the ministry which God has called you to do! Sure, some plans or changes might need to be put on pause for a bit. The vast majority of ministry at Messiah should be able to keep plugging along as normal. But, in order for that to happen, the congregation and communi- ty will need you to continue to share significant pieces of your time, talents, and finances. Don’t just as- sume other people will step-up and do what needs done. Take the initiative! If this family of faith is a pri- ority of yours, make sure your actions are reflective of that.
What does this transition mean for…the community?: • It means, because Pastor Lisa and I form a clergy couple, that Messiah, Bethel, and Moe will all be experi-
encing a leadership transition. So, Messiah is not the only congregation that is trying to navigate their way through this new and different time. As such, I would encourage you to try to continue partnering and shar- ing in ministry as much as possible with these sister congregations. In addition, I urge you to be immensely gracious with each other and members of the other churches. There is a lot of “figuring stuff out” that eve- ryone is working on so be loving, patient, and sympathetic to one-another.
Continued............
Pastor Michael’s message......continued
What does this transition mean for…the Beerys?: • It means that we can thin out our winter wardrobe and get rid of our snow blower. • It means we will be significantly closer to our families. • It means we are now given the opportunity to be co-pastors together at one phenomenal congregation. • It means, after June 9th, I can no longer serve as your pastor—a fact that has broken my heart. As much as
I’d like to, I can’t take you with me to NC (it’s so hot right now ya’ll would probably melt fairly quickly). While my love for you will continue long into the future, my time as your pastor has nearly concluded. One of the big questions from this reality that people have been asking about is if I can ever return to Mes- siah to preside at funerals, weddings, baptisms, or confirmations. The answer to that question is no. It’s not that I don’t want to, but such action would undermine your future pastor’s opportunity to develop his or her ministry with you. Being a part of these big life events is what helps you form a relationship with your pastor and vice versa. A different yet similar question which has been posed is: Does this mean I have to unfriend you on Facebook? No, you don’t. If you would like to stay connected via social media, we cer- tainly can! I’m not overly active on Facebook but if you’d like to “friend” me, feel free (as I mentioned in previous articles, that’s always been a choice I’ve let you make). I will likely keep a very low profile on Facebook amongst Roseau folks for similar reasons I’ve just touched upon.
This has turned into a bemouth of a newsletter article—sorry about that! I’ll try to be more disciplined and concise with the last few sermons I have! In wrapping up thinking about what does this mean, I’m reminded of Jesus’ last words to his disciples before he ascended to the Father. “I’m with you always, to the end of the age,” Jesus reassured them. The disciples were definitely pondering the meaning behind what they were ex- periencing. And while Jesus didn’t give them a lot of definitive answers, he promises that they don’t have to figure it all out on their own. As you all continue to reflect on what this transition means for you, Messiah, and the community, remember Jesus’ words—you’re not alone in this process! Jesus will lead you through it, just as he has been leading the people of Messiah Lutheran Church for the last 115 years. Grace and Peace, Pastor Michael
Message from the Council
On Sunday, May 19th, Bishop Larry Wohlrabe met with representatives from the councils of Messiah and Moe. Bishop Larry outlined the process we will follow to find an interim pastor who will serve both Messiah and Moe for the summer months. Bishop Larry is currently in conversations with a candidate for this in- terim position. The target is to have the interim pastor in place by July. After June 9th, we have pulpit supply scheduled for the remainder of the month of June. Moving into the fall, we will begin our call process to find our next pastor. We will keep the congregation informed as we move through the process. Thank you. Keith Okeson, Council President
We will begin worship at Messiah at 10 am. Then, before the communion
liturgy begins, we will head to the Roseau City park to join our friends from
Moe for a time of worship, communion, and fellowship. After the service,
we will share a farewell meal of hamburgers and hotdogs. The entire com-
munity is invited so please spread the word!
If you have them, please bring lawn chairs, not only for you but also extras
for those that may not. Also, because parking space is limited at the park,
please consider carpooling.
We hope you can join us in this time to say farewell to the Beery family, to
show them our gratitude for the time they shared with us, and to send them
with our prayers for where God has now led them.
MESSIAH YOUTH EVENTS:
Thursday, May 30th: 9th Grade Confirmation Evening Retreat:
6 pm-11:30 pm @ Messiah Lutheran Church! There will be supper, games, service Project,
one on one meetings with Pastor Michael, snacks & Worship!
HANG TIME YOUTH (For youth who just completed 3rd, 4th & 5th Grade)
JUNE 5TH: NOON-1:00pm: 4-6 GRADE YOUTH GROUP @ MESSIAH
(Free Lunch served, Highs/Lows, Group Builders and outdoor games)
7-12 GRADE R.O.C.K.: JR HIGH YOUTH (Youth who just completed 6th, 7th & 8th Grade)
JUNE 19TH: NOON-1:30pm: Jr High Youth Group @ MESSIAH
(Free Lunch served, Highs/Lows, Group Builders and Outdoor game)
SR HIGH YOUTH (Youth who just completed 9th, 10th, 11th and 12th Grade)
JUNE 26TH: NOON-1:30pm: Sr High Youth Group @ MESSIAH
(Free Lunch served, Highs/Lows, Group Builders and Outdoor game)
NEWS & NOTES:
• May 30th: 9th Grade Confirmation Retreat @ Messiah
• Monday, June 3rd @ 7pm: NEW Family Camp Fire/S’mores/Camp songs Night is a new Family Ministry Opportunity this Summer! We will try once a month and our first one will be next week at the Messiah Campfire Ring! Please bring lawn chairs, church will provide s’mores, drinks, campfire & songs around the campfire! This is for all ages and friends are welcome!
• Jay will be in Cities on June 10-12, back in office on Thurs, June 13th
• Wed, June 26, 6:00 pm: Rockford/Denver Mission Trip Parents/Youth Supper Check-In Meeting! We will have supper and more information and final payments
• JULY CALENDAR will come out on Wed, June 19th
Thanks,
11 a.m. Coffee & Fellowship
June 9 (Messiah): 10 a.m. Worship Pastor Michael’s last Sunday – Party at the Park following worship
June 16 (Messiah): 10 a.m. Worship
11 a.m. Coffee & Fellowship
10 a.m. Worship
11 a.m. Coffee & Fellowship
THINK: cereal, oatmeal, granola bars, etc.
Carts will be available in the narthex at each congregation. Items will be delivered at the end of each month.
Messiah Messenger Announcements
J UN E 2 0 19
RED! In the church year, the Day of Pentecost is the culmination of the 50 days of the Easter celebration. After showing himself to the disciples and after having ascended, Jesus’ fol- lowers received the promised gift of the Holy Spirit. Given the nature of the occasion as the closing of the most joyous season of the church, the Day of Pentecost deserves to be celebrated more enthusiastically than often is the case. The church’s witness to the pres- ence and power of Christ’s Spirit should never be obscured.
As a way to celebrate this festive day, everyone is invited to WEAR RED to worship on Sunday, June 9th. Red is often worn to worship on the Day of Pentecost recalling the red flames of the Holy Spirit. As we see the sanctuary full of red, we are reminded visually of the Spirit being ever-present among us.
MWELCA Circle Meetings Naomi/Ruth Circle: Will meet on Wednesday, June 19th at 9:30am at the Roseau Diner.
Prayer Chain Information!
Mary Olson (463-2364) is the of chairperson of Messiah's prayer chain. Kathy Erick-
son (463-3942) serves as the assistant. Whenever a prayer need or concern arises,
please give Mary or Kathy a call. And if you would like to be an active member of
the prayer chain, you can let Aimee in the office know: messiahroseau@gmail.com
Start registering for Pathways Day Camp today!
Our summer VBS/Day Camp will be at Messiah Lutheran Church and will begin with a kick-off on July 7th. The actual camp will run July 8th- July 11th. The cost is $30 per camper and $60 max per family. This day camp is for students
that just completed Kindergarten—6th grade. A free pre-school day is also offered on July 10th, from 9am—Noon. Registration materials are
available at the back of this Newsletter.
Congratulations 2019 Graduates!
Hunter McFarlane, Brodie Wensloff, Aaron Loken, Adam LePard, McKenna Schumacher, Kiana Flaig, Ellie Hedlund, Paetyn Spilde, and Madicyn Holmgren
On Monday June 3 rd , at 7 pm
at Messiah’s Campfire Ring we
will be hosting a Family Minis-
try Event. We will enjoy the
campfire, make s’mores and
sing camp songs around the
campfire. Please bring your
couraged!
J UN E 2 0 19
Sarah Wahlberg Scholarship Applications can be picked up at the church office or found on the Messiah Church website at
messiahroseau.net under the Resources tab.
Application deadline was April 19, 2019 for graduating Seniors and July 1, 2019 for returning students!
SUNDAY SERVERS NEEDED!
If you are available to Greet, Usher or Serve Coffee/Snacks:
Please contact the office to sign up, or write your name on the serving
schedule or respond to the volunteer request e-mails.
REMINDER! As you do your spring cleaning, please keep in mind the Messiah quilters and Bell Choir. The quilters are replenishing their supply of sheets and fabric and donations can be left at the church office or put on the shelf just off the Sunday school wing. Also, the Bell Choir will be having their annual rummage sale. We have decided it will
be held probably in August. As you go through your household items, please hold them for us. We will take anything except clothes. We will ask for the items right before the sale. Watch for further information.
~Radio Broadcasts~ We would like to encourage our membership to give radio broadcasts in memory or in honor of important events/people in our lives. The cost to sponsor a radio broadcast is $80. If you would like to sponsor a radio broadcast, you can put your donation in the offering, contact
Aimee at the church office, or signup on the sheet that is hanging on the message board near the entrance.
Messiah Messenger Announcements
J UN E 2 0 19
Pathways Celebrates 50 Years of Ministry in 2019, and invites you to join in the festivities!
This summer, there will be a celebration event at Camp Emmaus on Saturday, July 13th from 10am-5pm. Join us for a lunch-
eon, celebration worship, alumni reunion, and camp activities and games happening every hour. Come celebrate and reflect on the past as
Pathways strives to reach future generations for years to come. For more info and to RSVP visit
www.Facebook.com/PathwaysBibleCamps/events
Northwestern Minnesota Synod Assembly, June 7-9 This year’s assembly theme is:
Building a Bigger Table
The keynote speaker is:
We gather in assembly:
• to worship as a synod, gathered around God’s Word and Sacraments;
• to listen to one another, learning from and being inspired by God’s Word for the sake of God’s mission;
• to deepen our relationships in the synod—meeting, learning, worshiping, laughing and enjoying one another’s company;
• and to deliberate as a synod, carefully discussing and prayerfully deciding about issues before us.
Opportunities at the assembly:
• Through vibrant worship, to recognize and praise God as the Master Table-Builder.
• By dwelling in God's Word, to understand how all Christians are called to welcome all per- sons to God's Table.
• Through Spirit-empowered discernment, to welcome a new bishop to our synod table.
• By learning together, to receive "blueprints" for building bigger tables back home.
Please pray for those gathered at Synod Assembly June 7-9, including our own Gary and Vickie Wilson, as they participate in the ministry of the larger church.
Messiah Messenger Announcements
THANK YOU THRIVENT MEMBERS!
Messiah has received $5,891 through Thrivent Choice Dollars this year to date.
Thrivent Choice Dollars are funds designated to eligible Thrivent Members, based on insurance premiums, contract values and Thrivent Financial volunteer leadership.
Choice Dollars can be directed to thousands of nonprofit organizations nationwide, in- cluding local congregations.
*If you would like to designate Choice Dollars to Messiah but are unsure how to do so, please contact our local Thrivent Financial Associate:
Luke Erickson at 463-3573.
Messiah’s Financial Update Check Book Balance YTD Cash Inflow YTD Expenditure Ending Balance
Jan 2019– Apr 2019 $ 79,301.68 $ 71,588.95 $ 72,061.59 $ 78,829.04
Whenever you're unable to make purchases locally and you choose to shop at Amazon, a small percentage of your purchase can now be donated from
Amazon to help support the ministries of Messiah. Follow the link below to learn more. It’s super easy and every little donation directly benefits God’s work here at
Messiah and within our greater community. https://smile.amazon.com/ch/41-1344741
Have you “liked” & “followed” us on Facebook?
By liking our page you will gain access to pictures, updates, and articles that are helpful to our community of faith—a great way to
stay connected! Our page is called Messiah Lutheran Church and it can be accessed through the following link: https://www.facebook.com/pages/Messiah-Lutheran-h/419293738166238
Login at:
messiahroseau.breezechms.com
Mobile App Download the Mobile App from the App Store, Google Play, or from :
www.breezechms.com/mobile-app
Church ID: messiahroseau
What Can I Do? With Breeze you can see and manage:
Personal & Family Information
tab Scroll through the list of People
Or search for a person via the search
on the left-hand side of the page
How do I… ?
Click the My Profile
Single click on “Click to Edit Section”
Click the green “Save” button when
done editing
“Attendance”
Choose your fund
Enter your payment Information
Choose “One Time Gift”
Contact the church office if you would like to set-up a recurring contribution Click “Donate Now”
See My Giving History
Click the My Profile
See Events & Event Details
“Events” tab When the calendar appears, click on an
event title for more information
How do I… ?
Open & Log In to the Breeze App
Click the menu icon
check in to
Type your last name in the search bar
Click the for yourself and all family
members you would like to check in
We will have a “Check-In” table in the
narthex each Sunday for those that do not have the Breeze app
Where can I find help? The Breeze Champion at my church is:
Aimee Wilson E-mail: messiahroseau@gmail.com Church Office Phone: 218-463-1648
As you may have heard, the church has transitioned to a new church management software called Breeze. At the beginning of January we sent invitation e-mails to all members to set up a Messiah Member Account in Breeze. The following is a summary of what you can do with your Breeze account along with a couple “How To’s.” Please let Aimee in the church office know if you have any questions.
: An Introduction
Holy Communion Servers (first name listed also sets up communion)
June 2 (Intinc) Cheryl Schleppenbach, Roxanne Fabian, Eileen Carter
June 9 (Intinc) Communion at the Park
June 16 (Intinc) Gloria Skrutvold, Carolyn Sabourin, Kathy Howard
June 30 (Intinc) Bonnie Delmore, Barb Erickson, Micky Slater
Lay Reader Scripture Readings
June 2 Marsha Hagen Acts 16:16-34; Psalm 97; Revelation 22:12-14, 16-17, 20-21; John 17:20-26
June 9 Mark Wilson Acts 2:1-21; Psalm 104:24-34, 35b; Romans 8:14-17; John 14:8-17 [25-27]
June 16 Carolyn Sabourin Proverbs 8:1-4, 22-31; Psalm 8; Romans 5:1-5; John 16:12-15
June 30 Bill Jennings 1 Kings 19:15-16, 19-21; Psalm 16; Galatians 5:1, 13-25; Luke 9:51-62
Greeters Counters
June 9 Curtis & Gloria Skrutvold June 9 Jon & Bonnie Hagen
June 16 Dennis & Carolyn Sabourin June 16 Stu & Beth McFarlane
June 30 John & Eileen Carter June 30 Duane & Barb Erickson
Coffee/Snacks Council Rep
June 9 Fellowship Meal at the Park June 9 None
June 16 Dennis & Carolyn Sabourin June 16 Allen Olson
June 30 June 30 Rob Larson
Ushers Sound Booth
June 2 Dan & Jodie Janzen June 2 Ryan Lisell, Jon Hosaluk
June 9 Mark, Max & Bryn Wilson June 9
June 16 June 16 Karyn Santl, Bob Tuttle, Isaac Moser
June 30 June 30 Paul Grafstrom, Sam Grafstrom
SERVING SCHEDULE - JULY & AUGUST
Holy Communion Servers (first name listed also sets up communion)
July 14 (Intinc) Nancy Tveit, Bonnie Hagen, Caroline Majer
July 28 (Intinc) Bill & Sue Jennings, Mark Wilson
August 11 (Intinc) Roxanne Fabian, Eileen Carter, Cheryl Schleppenbach
August 25 (Intinc) Kathy Howard, Barb Erickson, Gloria Skrutvold
Lay Reader Scripture Readings
July 14 Dave Grafstrom Deuteronomy 30:9-14; Psalm 25:1-10; Colossians 1:1-14; Luke 10:25-37
July 28 Mark Wilson Genesis 18:20-32; Psalm 138; Colossians 2:6-15 [16-19]; Luke 11:1-13
August 11 Carol Guy Genesis 15:1-6; Psalm 33:12-22; Hebrews 11:1-3, 8-16; Luke 12:32-40
August 25 Jessica Howard Isaiah 58:9b-14; Psalm 103:1-8; Hebrews 12:18-29; Luke 13:10-17
Greeters Counters
Coffee/Snacks Council Rep
July 28 July 28 Bonnie Hagen
August 11 August 11 Larry Hosaluk
August 25 August 25 Keith Okeson
Ushers Sound Booth
Council Minutes April 11, 2019
The meeting was called to order in the name of the Father, Son and Holy Spirit. Larry led devotions. MEMBERS PRESENT: Pastor Michael, Jodie Janzen, Bonnie Hagen, Allen Olson, Marty Trangsrud, Keith Okeson, Rob Larson, Larry Hosaluk, Shelly LaPlante MEMBERS ABSENT: Bonnie Delmore Caring Conversations: When you think of a favorite place, what are the smells that you associate with it? Additions/Changes to the Agenda: Added to New Business – Utilities Usage Review. Adoption of the agenda with one addition was made on a motion by Shelly, seconded by Allen. Carried. SECRETARY’S REPORT: A motion to approve the minutes from 3/21/19 meeting made by Jodie, seconded by Larry. Carried. TREASURER’S REPORT: A motion to approve the Treasurer’s Report was made by Bonnie H., seconded by Rob. Carried. OLD BUSINESS: A. Goals & Visioning for 2019:
• Suggested something outside of our Messiah walls (community).
• Assistance with Volunteer Engagement
• Financial assistance with “Trunk & Treat” Planning Committee consisting of the Executive Committee will meet to prioritize, itemize and create a plan for the Goals & Visioning for 2019. B. Audit Committee Update: Allen outlined the preliminary audit report. Complete audit will be forwarded to Pastor Michael. Motion to approve by Rob, seconded by Larry. Carried. NEW BUSINESS: A. Secretarial Update: Pastor Michael, Keith and Bonnie H. met to review Aimee’s job description as Office Administrator (new title). Also
discussed any likes and dislikes she has expressed to date. This committee suggested increasing her salary to $14.50 per hour. A motion to approve was made by Allen, seconded by Jodie. Carried.
B. Staff Check-In Dates: Check-ins are completed three times a year. Keith, Larry & Sue Grafstrom will meet with Pastor Keith. Pastor Mi- chael, Keith, Shelly and Marty will meet with Jay. Dates to be determined in the near future.
C. Thank Yous: Messiah has received several Thank You Notes which were distributed for review. These will be posted on the Bulletin Board for the congregation to see and a note will be included in the next Newsletter.
D. Utilities Usage Review: Ryan Lisell has been working on our boiler and since completing his work, our usage and billing has been significant- ly less. Aimee has been in contact with the Natural Gas Company questioning this situation and they see no problem on their end. It was sug- gested that we take a picture each month of the actual readings. Keith will check with the Maintenance Boiler Accredited Personnel at the hospital for clarification and see if they have any suggestions.
REPORTS: A. Pastor Michael highlighted items from his written report (attached). B. Jay: No report this month. COMMITTEE REPORTS: A. Parish Ed (liaison: Shelly LaPlante, next meeting: 4/10/19 @ 7:15pm). Committee is looking at new curriculum for mixed age groups.
Pathways forms to be handed out this Sunday. End of Year Congregational Event with carnival and snacks being planned. B. Property (liaison: Rob Larson, next meeting: 4/9/19 @ 6:30 pm). John Wahlberg is the new Chairman. Lists of projects and assignments
will be prioritized soon. Would like to add the church kitchen to the list for updating. C. Stewardship (liaison: Bonnie Delmore, next meeting 5/2/19 @ 11:30 am) D. Worship Planning (liaison: Jodie Janzen, next meeting 5/9/19 @ 5:15 pm) E. Youth & Family (liaison: Marty Trangsrud, next meeting 3/25/19 @ 5:30 pm). Three fundraisers have been completed for mission trips this
summer. Planning End of the Year Party with Parish Ed. Next meeting is 4/13/19.
UPCOMING EVENTS: A. Maundy Thursday Worship (April 18th) with First Communion celebration B. Community Good Friday Worship at Moe at Noon (April 19th) C. Good Friday Fish Fry – April 19th D. Easter Sunday – April 21st E. Sunday School Wrap-Up & Congregational Picnic – May 5th
Devotions Next Month: Keith NEXT MEETING: Thursday, May 16, 2019 at 5:30 PM Meeting adjourned on a motion by Jodie, seconded by Allen. Carried. We closed with the praying of the Lord's Prayer. Respectfully submitted, Bonnie Hagen, Secretary
Pathways Day Camp Registration Form
Camper Name ____________________________________________ M ____ F ____ Address_____________________________________ Home Phone______________ City _________________________________________State ______ ZIP __________ Birthdate ___________________ Age_______ Grade (2018/19 school year) ________ Dietary Restrictions/Special Emotional/Physical Needs ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Parent/Guardian __________________________________________________________ Best Contact Phone (____) ______-_____Primary email address _________________ 2nd Parent/Guardian ____________________________________________________ Best Contact Phone (____) ______-_____ Primary email address _________________ Emergency Contact (Other than Parent/Guardian) _____________________________ Emergency Contact Phone Number ____________________________
Who: Completed K through completed 6th Grade
• A FREE pre-school (4 & 5 year old) half day will be Wednesday, July 10th!
When: July 7 – 11
• Day Camp begins July 8th at Messiah
Where: Hosted at Messiah this year
Time: 9 a.m. to 3 p.m. July 8 – 11
Cost: $30 per child; $60 maximum per family
Dates to Remember:
• All registrations due by June 20th! The earlier, the better!
• Sunday, July 7 – Meet counselors during worship
• Monday, July 8 – Thursday, July 11 Day Camp
• Wednesday, July 10 – Cookout and Program at Messiah
How to Register:
• Complete Pathways’ registration forms
• Turn in child/family forms and payment payable to Messiah Lutheran Church at church office
Register for Pathways Day Camp now!
PATHWAYS, INC. YOUTH HEALTH HISTORY Health information on this form is held confidential unless there is a medical emergency
Name _____________________________________ Camp Attending/Program ______________________
Address (if different than above) ______________________________________________________________________
Emergency Contact (name and relationship) _____________________________________________________________
Home Phone _________________________________Work Phone __________________________________________
INSURANCE COMPANY _______________________________ POLICY NUMBER _________________________________
IF YOU DO NOT HAVE INSURANCE, LIST YOUR SS# _______________________________________________________
FAMILY DOCTOR ______________________________________CLINIC/CITY ____________________________________
PHONE NUMBER _________________________________________________________________________________________
HEALTH HISTORY
(If participant has had in the past, please give approximate date(s). If participant HAS NOW, please mark with a “N”)
__________ ADD / ADHD __________ Asthma (We require you have your inhaler readily available.) __________ Anorexia / Bulimia __________ Appendicitis __________ Arthritis __________ Constipation __________ Convulsions __________ Depression __________ Diabetes __________ Diarrhea __________ Bed Wetting __________ Ear Infections __________ Fainting Spells __________ Headaches __________ Hepatitis __________ Nervousness __________ Pregnant __________ Ulcers __________ Sleep Walking __________ Homesickness __________ Sinus Trouble __________ Measles __________ German Measles __________ Mumps __________ Tonsillitis __________ Chicken Pox __________ Bronchitis __________ Bleeding Disorders __________ Hypertension __________ Heart Defect/Disease __________ Seizures (Please describe.) __________ Cramps __________ Mononucleosis __________ Rheumatic Fever Other: _______________________
ALLERGIES
_____ Hay Fever _____ Insect Stings _____ Poison Ivy _____ Penicillin _____ Food Products _____ Other Drugs _____ Other: _____________________________
IMMUNIZATIONS
_______ DPT Permanent Shots _________ Tuberculin _______ Polio Immunization _________ MMR _______ Tetanus Booster _______ Other: _______
Other illness or needs that may affect participation ______________________________________
Surgeries or serious illnesses & dates _________________________________________________
Dietary restrictions _______________________________________________________________
Swimming ability: ____ Non-Swimmer ____ Beginner (avoids deep water) _____Intermediate
(Note: If swimming should be restricted, please note under “restricted activities” above.)
________________________________________________________________________________
If not, has it been discussed? _____ Yes _____ No
If so, is her menstrual history normal? ____ Yes ____ No
MEDICATIONS
Does this person take medications on a regular basis? __________ If yes, please list ALL medications (prescription and non-prescription) taken routinely: ________________________________________ ________________________________________ ________________________________________ ________________________________________ May acetaminophen/ibuprofen be administered if needed? ___YES ___ NO
People with the following medical conditions should consult a physician prior to attending the program. 1. If you have a history of heart problems or high blood pressure, you are at risk
if you physically participate in this program. Due to the types of physical de- mands inherent to the activities you may be jeopardizing your health and well being if you choose to fully participate.
2. 2. If you are pregnant, you and your unborn child are at risk if you participate physically in this program. Unintentional impacts to your abdomen can occur during many of the activities that involve physical contact.
3. If you are recovering from broken bones, dislocated joints, sprains, strains, back or neck injuries, you are risking re-injury if you participate physically in this program.
4. If you have an enlarged organ, are a transplant recipient, or have Downs Syndrome, you are risking injury to the weakened areas of your body.
Pathways, Inc.
Assumption of Risk, Medical Authorization, and Publicity Consent Form
By signing this release form I agree to release and hold harmless Pathways Inc., its agents, employees,
facilitators, and others, (hereby referred to as “Pathways, Inc.”) for any damage or injuries, physical or
mental, which I might incur as a result of my voluntary decision to participate in all facets of a Pathways,
Inc. program, which may or may not include the Challenge Course program at Camp Emmaus.
If I do voluntarily choose to participate in the program, I recognize that there is a significant element of
risk in any adventure, sport, or activity associated with the outdoors. Knowing the inherent risks, dan-
gers, and rigors involved in the activities, I certify that I am fully capable of participating in the activities.
I understand that Pathways, Inc. has the right to deny participation if there are any safety concerns.
I assume full responsibility for myself for bodily injury, sickness, disease, death, loss, or damage, and
expenses thereof, as a result of my negligence, or other risks, including but not limited to those caused
by the Challenge Course at Camp Emmaus, the terrain, the weather, my athletic and physical condition,
and other participants.
By signing this release form, I agree that if I do sustain any physical injury or mental damage of any na-
ture as result of my voluntary decision to participate in the Pathways, Inc. program, I voluntarily agree
to hold harmless and release the above named parties from any liability therefore and that this release is
binding on my heirs and assigns. I agree to accept financial responsibility for any medical expenses
and/or loss of income not covered by my insurance policy. In the event of an emergency, I authorize the
Pathways, Inc. staff to seek emergency medical treatment.
By signing below I authorize Pathways, Inc. to use any photos or video taken during the visit to Path-
ways, Inc. in publicity materials for Pathways, Inc.
I acknowledge that I have been given the opportunity to ask questions regarding any aspect of this re-
___________________________________________________ _______________
____________________________________________________ _______________
____________________________________________________ _______________
_____________________________________________________________________________