(updated 2/5/06 )

Youth >

Summer Camp/Retreat/Mission Registration

 

Camp/Retreat/Mission
 All Youth Retreat (August 5 - 7)
Youth's Name:
 M F
  DOB - -
Age
Grade youth will enter Fall of 2005
  School
Does youth attend church? Yes No
  Where?
  Member? Yes No
Is there a friend your youth
would like to travel and room with?
Allergies/Medical Information
Other Information
     
     
Parent's Name:
  
Email:
Phone:
Address:
City:
Zip :
I would like to help drive
    chaperone
    send food
     
     
Emergency Contact:
  
Relationship to youth:
Phone:
Emergency Contact:
  
Relationship to youth:
Phone:
Question or Comment:
     
     
I grant permission for my child to participate in Youth Camp/Retreat/Mission and release the church of all liability.
Electronic Signature
Date - -
   
 
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