Registration - Middle School Retreat

Child's First Name

Child's Grade

Father's Full Name

Child's Last Name

Child's Birthday

Mother's Full Name

Parent's Primary Email

Primary Phone

Address

Emergency Contact Name

Emergency Contact's Phone

Child's special considerations, allergies, or medications

I accept the liability release policy. ( Required )View policy here

I accept the permission to seek emergency care policy. ( Not Required )View policy here

I accept the media release policy. ( Not Required ) View policy here

I accept the permission to contact youth policy. ( Not Required )View policy here

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