Disciple Now 2023
Disciple Now is a retreat for students 6th-12th grade.  It takes place at Timber Creek Camps in Pulaski, MS.The retreat is filled with times of worship, Bible Study, and fellowship to encourage teens to grow in their relationship with Jesus.  
When: Friday, February 3 - Sunday, February 5, 2023 (Arrive at CVBC at 4:15pm)
Where: Timber Creek - Pulaski, MS
Cost: $110
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Student's First Name *
Student's Last Name *
Gender *
Current Grade *
6th
7th
8th
9th
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11th
12th
Grade
T-Shirt Size *
Parent/Guardian Name *
Parent Guardian E-mail
Parent/Guardian Cell Number *
Student Cell Number (optional)
Medical, Liability and Photo Release (Please read the following)
I understand that in the event my student requires medical or dental treatment while engaged in activities with Clarke-Venable Baptist Church, reasonable efforts will be made to contact me; if I cannot be reached, I hereby consent and give permission to the ministry's sponsor or any adult sponsor acting on behalf of the ministry with respect to church activities as agent for me.  I understand all reasonable safety precautions will be taken at all times by Clarke-Venable Baptist Church and its agents during the events and activities.  I understand the possibility of unforeseen hazards and know the inherent possibility of risks.  I agree not to hold Clarke-Venable Baptist Church, its leaders, employees, land owners, and volunteer staff liable for damages, losses, diseases, or injuries incurred by this student.

I also consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of this student during the event to be used, distributed, or shown as Clarke-Venable Baptist Church sees fit.
Do  you consent to the above statements? *
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Student Code of Behavior (Please read the following)
I will represent Christ everywhere I go and in everything I say and do.  I will be respectful and obedient to all adult chaperones at all times.  I understand there will be absolutely no alcohol, tobacco, cigarettes, drugs, fireworks, weapons, knives, lighters, or any form of pornography brought, bought, or consumed/used on this trip.  I will follow the directive of leaders in the use of personal electronic devices.  I will not participate in public or private displays of affection.  I will help load and unload the bus.  I will never go anywhere alone.  I will dress clean, neat and modest.  I have reviewed the following expectations and agree that my child will abide by them.  
My student agrees to abide by the above conduct policy *
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Parent/Guardian digital Signature *
By Clicking yes I agree that this is my signature *
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