Register HS Boy Youth Spring Retreat 2025

Student name

Grade

Address

Date of Birth

Parent or Legal Guardian Information

Parent Name

Relationship to Camper

Phone

This address will receive a confirmation email

Address (if different than above)

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

Health Information

Insurance Company

Primary Insured on Policy

ID Number

Group Number

Primary Care Physician

Primary Care Physician Phone

Please list any health concerns which require special attention (include any restrictions on activity)

Please list any medications to be administered by our staff

Please list any allergies

Parent/Guardian Consent

As parent or guardian, I/we hereby give my/our permission for the above named student, my/our minor child, to attend the Spring Retreat organized and sponsored by Foothills Church April 25-27, 2024 at Aldersgate, 7790 Marion Rd SE, Turner, OR 97393. This permission does not include transportation, as this will be provided/arranged by parents or guardians. I also understand that my student needs to abide by the rules of onsite church leadership during the course of the event.

I am aware in signing this document for the above mentioned student’s participation in Foothills Church’s retreat that certain elements of these activities are physically and emotionally demanding. Furthermore, I/we understand and acknowledge the potential risks and dangers involved in the participation of this retreat and I have voluntarily authorized their participation in these events and treatment of minor injury and/or admission to a nearby medical treatment center if necessary.

In consideration of being allowed to participate in Foothills Church’s retreat, I/we hereby personally assume for my minor child, all risks in connection with said program for any injuries or damages which may occur to my child as participants and do fully and forever release the church, its employees, affiliated organizations, and volunteer staff from any and all claims, demands, damages, rights of action or causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of the participant’s commencement of the activity or use of the facilities, equipment and property of Foothills Church except in the case of negligence. I do, on behalf of my child, agree to indemnify and hold harmless Foothills Church and the employees and volunteer staff thereof from any liability and expenses for personal or property damage or injury not caused by their negligent actions.

My electronic signature on this document is also intended to bind my successors, heirs, representatives, administrators and assigns.

Electronic Signiture, please type full name.

Payment Information

The Youth Spring Retreat cost is $140 and is due in full by March 31.

Total ($140)

Description

April 25th-27th. Meet at Aldersgate at 5:00 pm Friday. Pick up students Sunday at 11:30 am

Join us for the Middle School Spring Retreat! On Friday, April 25th at 5:00 pm we will meet at Aldersgate Camp - 7790 Marion Rd SE, Turner, Oregon 97392 for an amazing time and a ton of fun. Students need to be picked up on Sunday, April 27th at 11:30 am.
Registration and full payment of $140 are due March 31! Spots are limited and secured in order of registration and full payment received.

Checks should be written to Foothills Church. If mailing the check, mail to Foothills Church, 975 Fern Ridge Road, Stayton, OR 97383.

Register HS Boy Youth Spring Retreat 2025

Description

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