2024 GMC YG SUMMER RETREAT APPLICATION

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June 25-28 (Tuesday - Friday)

Refreshing Mountain Retreat Center, Lancaster, PA

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"Abide in Me"

*Please fill out a form for EACH CHILD.
*각 자녀별로 작성 바랍니다.

CHILD'S FULL NAME / 자녀 영문 성명 *

AGE / 나이 *

GENDER / 성별 *

Male / 남

Female / 여

HOME ADDRESS / 집주소 *

Emergency Contact / 비상 연락자 (영문 성명) *

Relationship to Child / 관계 *

Father / 부

Mother / 모

Other / 기타 __________________________________________

Emergency Contact Number / 연락처 *

Food Allergies / 음식 알러지 *

Medications / 약물 *

RETREAT FEE / 수련회비 *

*1st Child: $150
*2nd Child: $125
*3rd Child: $100

*Please add "YG Retreat: Child's Name" on all payments
*Put CASH & CHECK payments into Offering Box at GCC

* ALL FEES are due by June 9, 2024.

CASH / 현금

CHECK / 수표 (Payable to " NJ GMC")

Venmo (Pay to "@NewJerseyGospel-MissionChurch")

Authorization for Treatment & Release: * I, the undersigned, do for myself (or for and on behalf of my child under 18 years of age) give permission for an attending physician or hospital to administer medical care if deemed necessary by a physician. I, the undersigned, do for myself (or for and on behalf of my child under 18 years of age) hereby release from all claims and forever hold harmless the director, employees, volunteers, and agents of New Jersey Gospel Mission Church from any and all claims and demands for personal injury, sickness, and death, as well as property damage and expense, of any nature incurred by myself (or my child under 18 years of age). I assume personal responsibility for any loss of property incurred by myself (or my child under 18 years of age) at the event by theft or otherwise. I also assume personal responsibility for all medical bills (for myself or child under 18 years of age). Further, should it be necessary for me or my child to return home due to disciplinary action*, for medical reasons, or otherwise, I hereby assume responsibility for all transportations costs.

*Possession of cigarettes, illegal drugs or weapons will result in immediate return home without refund.

I have read and agree with the above authorization.

必填

SIGNATURE / 서명* *

*This box MUST be signed in order for your child to be permitted to attend this retreat.
*아래에 표시하셔야 자녀가 수련회를 참석할 수 있습니다.

*Checking this box will serve as your consent & signature.

必填

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