Camp Registration

Winter Retreat 2020

Parent Last Name *

Parent First Name *

Phone Number *

Mailing Address *

Mailing Address Line 2

Home City *

Home State *

Home Zip Code *

Email Address *

Student Last Name *

Student First Name *

Student Gender *

Male

Female

School Grade *

Participation Agreement

1. I understand that I will be expected to keep the youth leaders informed of my whereabouts at all times and leaving the group or retreat area without a leader or leader’s permission is dangerous and not permissible.

2. I will not participate in cruel talk or mean joking.

3. I will follow the instructions of all leaders.

4. I understand that I will NOT show any PDA if I am not married.

5. I understand the need for the assigned sleeping arrangements and I will honor this.

6. I understand that I am not allowed to POSSESS or USE tobacco, alcohol, or any other type of illegal substance.

7. I understand that I am not allowed to POSSESS or USE firearms, fireworks, or any weapons on this trip.

Consequences

Section 1-4

You will be assigned an adult to spend the remainder of your time alongside. You may not get to participate in further activities.

Section 5-7:

You may be sent home immediately.

I, the guardian, and my child (children) have read and understand the participation agreement and agree to these terms *

I Agree

Medical Information

Emergency Contact: First and last name *

Emergency contact phone number: *

Relationship of Emergency contact to student *

Student food allergies/ medications/ or any other pertinent information *

Family Doctor *

Insurance policy/ group number *

Health Insurance Company Name *

Parental Consent

I have read this form and agree to all terms

I Agree

I, the parent or guardian of the student named on this application, certify that he/she has my full approval to participate in this off-campus events with the GBC youth ministry. The Youth Pastor of GBC or designated adult leader assumes responsibility for discipline during this event and reserves the right to require a student to leave the trip because of misconduct or disobedience. In such an instance, I will assume full responsibility for returning the student home.
Further, I do release and hereby agree to hold blameless Grace Bible Church, designated leaders and sponsors, and other agents from any and every claim arising, or which may be asserted by me or by any member of my family by reason of participating in this GBC sponsored event.
Further, in the event I cannot be reached by phone, I do authorize the designated leaders of Grace Bible Church to give consent to a physician and/or hospital for emergency medical or surgical treatment of my child under their supervision. It is understood that I will assume all financial responsibility for any expense that may be incurred for such treatment.
I do authorize GBC to transport my child for this event.
By clicking the box on this page I give my consent to these conditions.

By clicking this box you are agreeing that you have read and agree to the terms and conditions on this form. *

I Agree and Give My Consent