St. Rose of Lima

A Catholic Church located in Gaithersburg, MD

All Are Welcome • Todos Somos Bienvenidos

Pray ... Grow ... Serve
Orar ... Crecer ... Servir

Flocknote

Butler's Orchard Hayride 2018

- Faith Formation

Middle School Hayride & Bonfire

October 2018

High School Hayride & Bonfire

October 2018

Join us for an evening of games, hayride, football, frisbee, s'mores and music!
We will meet at Butler's Orchard at 6 PM. Pickup is also at Butler's Orchard at 8 PM.
See directions below for more info about drop-off and pickup.

Reserve your space early!
We have a limited amount of space on the Hayride,
so make sure to register (using the form below) to secure your space.
Once you register below, please print and sign the permission slip (parents & youth).

The Details

Activity: Youth Ministry Hayride & Bonfire
Date: October (TBD) 2018
Place: Butler's Orchard (22222 Davis Mill Rd, Germantown, MD 20876)
Times: Drop off at 6 PM, Pickup at 8 PM (check-in immediately to secure your spot on the Hayride)
Cost: $15 (Hayride, snacks & supplies included)
Dress: Warm, layered clothes & covered shoes
Parents/Friends: Parents and families are welcome! We can always use more chaperones and it is a lot of fun. Friends of youth and teens are welcome, but they must register here. Parents: Let Molly know if you can come to help!
Deadline: Register online by TBD
Weather: If the weather is bad, cancellation will be sent via text on Flocknote.

Directions to 22222 Davis Mill Rd, Germantown, MD 20876 (Butler's Orchard)
- Head north on 355 or 270 and then go north on MD 27. At the top of the hill near the light, look for the Butler's Orchard sign on 27 and make a right down Brink Road. Make your first left on Wildcat Rd. Follow the twists and turns through the woods. Make sure to watch out for that sharp left turn just before Butler's! You will see the main building on the left. It will be twilight or very dark, so make sure to drive slowly and watch for folks walking along the road. Drive past the main building on the left and join us in the fields (path on the right) at 6:00 PM. Check-in immediately to make sure we have you on the list for the hay wagons. Rides home should arrive to the field by 8:00 PM. We will not be providing rides from or to St. Rose.
Instructions to Register
1. Fill out Registration Information Below by Monday, October 16th (spots are reserved on a first come, first serve basis)

2. Download the Parent & Youth Activity Permission Form print and sign it (both parents and youth must sign).

3. Bring the Parent & Youth Activity Permission Form & $15 in cash or check ("St. Rose of Lima") to Butler's Orchard on the day of your event or by Monday, October 16th to the Parish Office.
The maximum number of form submissions has been reached. This form is currently not available.
- PARTICIPANT INFORMATION
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- High School or Middle School? REQUIRED Middle School - TBD High School - TBD Please fill out this field.
- Date of Birth (MM/DD/YYYY) REQUIRED
  MM/DD/YYY
  Please fill out this field. Please enter a date.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- School & Grade Please enter valid data.
- PARTICIPANT MEDICAL INFO
- Allergies REQUIRED Please fill out this field. Please enter valid data.
- Medications REQUIRED Please fill out this field. Please enter valid data.
- Other health concerns REQUIRED Please fill out this field.
- Insurance Company Name REQUIRED Please fill out this field. Please enter valid data.
- Insurance Policy Plan Number Please enter valid data.
- Insurance Company Phone # REQUIRED Please fill out this field. Please enter valid data.
- EMERGENCY CONTACT INFORMATION
- Emergency Contact #1 (Parent/Guardian)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relation to Participant REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Other Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Emergency Contact #2 (Parent/Guardian preferred, may be neighbor/family/friend)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relation to Participant REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Other Phone Number REQUIRED Please fill out this field. Please enter a phone number.
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Butler's Orchard Hayride 2018

Middle School Hayride & Bonfire

October 2018

High School Hayride & Bonfire

October 2018

Instructions to Register

PARTICIPANT INFORMATION

PARTICIPANT MEDICAL INFO

EMERGENCY CONTACT INFORMATION