Event registration
When: Friday, November 4 - Saturday, November 5
We will meet at the church garage parking lot at 3:45 pm Friday, November 4 and depart by 4:00 pm. We will return to the church garage parking lot by Saturday, November 5 at 8:00 am. 
If you have any questions please contact Pastor James at (304) 920-5005 or jwalsh@johnstonchapel.org
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Student's Name *
Student's Email
Parent's/Guardian's Email *
Parent's/Guardian's Phone Number  *
Secondary Emergency Contact Phone Number (We will contact main parent/guardian first *
Dietary restrictions *
Allergies *
I understand that I will have to pay $60 upon arrival *
Required
PARENT SIGNATURE (below) agreeing that I give my permission for my child to participate in the Word of Life REVERB. In the event that my child would need emergency medical treatment, I give permission for the adults in charge of the group to secure the necessary treatment to protect the life and health of my child. I understand that I will be contacted before any medical treatment has begun except where a delay in treatment would not be in the best interest of my child.
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