CMC Youth Winter Retreat Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Camp Yolijwa, 2/11/21 - 2/13/21
Departing from Central Manor Church on 2/11/21 at 5:30 PM
Returning to Central Manor Church on 2/13/21 at 3:30 PM (approximately)

Cost: $110 (Discounts Available)

 Early bird (Jan 9) $10 off
 Sell 25 or more sandwiches $5 off
 Siblings $5 off per sibling
 Bring a friend $5 off/friend goes for $50

Participant Name *

Participant's Birthday *

YYYY

Brought By

Participant Grade Level *

Parent's Name(s) *

Email Address *

Address *

Parent Phone Number *

Emergency Contact Information *

Alternate Emergency Contact Information

Does this child have any medical conditions or food allergies we should be aware of? *

Can you child be photographed while attending the youth retreat for social media post or future promotional material? *

Yes

I give permission for the named child to attend and to be transported to Central Manor Church of God's Youth Winter Retreat at Camp Yolijwa, 2/11/21 - 2/13/21. *

Yes

In the event of an emergency or an injury and I cannot be reached I give permission for my child to be treated by qualified medical personnel at closest hospital. *

Yes

By clicking the submit button you are waiving all claims against Central Manor Church of God, Washington Boro, PA, it's employees and agents, in case of accident or injury, that may arise as a result of participation in activities or sponsored events either in whole or in part by the church. I further agree to hold Central Manor Church and its agents harmless and to indemnify them against all losses, liabilities, suits, claims, or expenses, including fines, penalties, and attorney's fees due to any injury to my child incurred in connection with the operation of the activities or transportation thereto. I also assume responsibility for any damages to the facilities caused by my child. *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms