2024 Youth Retreat Registration 
March 15-17, 2024
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Name *
Address *
City
State *
Zip Code *
Phone Number *
email *
My Church & City
Gender *
T-shirt Size *
Roommate Request
Parent or Guardian *
Parent or Guardian Address (include City, State & Zip) *
Parent or Guardian Phone Number *
Medical Insurance Company with Policy & Group Number *
List any allergies including food *
Please list any health or medical issues that camp should be aware of.  
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List any prescription medicine the camper will be bringing with them.
By signing below, I give permission for my child to participate in the normal activities associated with Camp Merrill, including hiking, sledding and zip lining.  Any exceptions are listed on the Health Form under “Camper Restrictions.”  I realize that some of these activities may involve dangers and risk of bodily injury.  I hereby and voluntarily release, discharge, waive and relinquish any and all loss or damages or actions or causes of action for personal injury, property damage or wrongful death occurring to my child during his or her stay at Camp  Merrill. , I understand, acknowledge and accept full responsibility for any and all inherent, open and obvious risks to sickness, exposure to infectious/communicable disease.   I give permission for the camp to administer medications as it deems necessary to my child.  This includes medication sent with my child, or nonprescription medications available at camp. In case of an emergency I understand every effort will be made to contact me.  In the event I cannot be reached, I here by give my permission to the physician selected by the camp to hospitalize and secure proper treatment (including surgery) for my child. I give permission for any photos taken during camp to be used for camp publicity. If the staff deems it necessary for my child to be removed from camp, due to disciplinary or other problems, I will respond by promptly coming after my child. My typed name below as the parent or guardian is my acceptance of this waiver.
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