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Fall Retreat 2019
Register here for the Maine District NYI Fall Retreat
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* Indicates required question
Email
*
Your email
Name of the student attending
*
Your answer
Is the student male or female?
*
Female
Male
Grade
*
6th
7th
8th
9th
10th
11th
12th
Parent/Guardian name & phone number
*
Your answer
Additional parent/guardian name & phone number
Your answer
Who, other than the parents/guardians named above, is allowed to pick up your child from retreat?
Your answer
Does your child have any allergies that we need to be aware of?
*
Yes
No
If yes, please name the allergy and treatment.
Your answer
Does your child need to take medication while at retreat?
*
Yes
No
If yes, please name the medication as well as the dosage. All meds must be kept in original containers and passed in at registration.
Your answer
Please check the over the counter medications that we are allowed to give your child while at retreat. Medication will be given based on dosage instructions on the label.
Tums
Tylenol/Acetaminophen
Advil/Ibuprophen
Pepto Bismol
Other:
Are there any concerns that we can address to make you or your student more comfortable at retreat? If yes, please explain.
Your answer
Church you attend or are affiliated with.
*
Your answer
Please check if you agree to the following.
I agree to not hold liable the Maine District NYI, its employees, and/or its volunteers liable for any injury that may happen to my child while attending Fall Retreat 2019.
A copy of your responses will be emailed to the address you provided.
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