GSM Spring Retreat 2023

Student Name

Student Age & Grade

Student Gender

Male Female

Parent Email

This address will receive a confirmation email

Emergency Contact Phone Number

What days are you able to attend?

Friday Saturday Sunday

Are you willing to be a driver? How many students can you safely bring to and from camp?

Dietary Restrictions None Vegetarian Vegan Kosher Gluten-Free Other...

I understand that I will have to pay $$ upon arrival

Yes

I hereby give permission for this student to participate in activities of Grace Church, Marshalltown, IA. This includes all sponsored activities on and off the Church property (including any and all activities involving travel and/or lodging) unless otherwise stated. I understand that reasonable precautions will be exercised by the adults chaperoning each event and that adults will adhere to the safety policies at all times. This permission shall remain in effect until August 31, 2023, unless terminated in writing. I hereby give permission for this student to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in church activities. I understand that drivers for all events must be over age 18 and approved by Grace Church Staff. In addition, I understand that my child may be photographed or recorded during the course of student ministry events and gatherings. By signing below I provide consent for their image to be used in either print, electronic, or video form for the promotional purposes of Grace Student Ministries.

Yes, I give permission

I understand I will be notified in the case of a medical emergency. However, in the event I cannot be reached, I authorize the approved Grace Church chaperone in charge to obtain any necessary medical attention in case of sickness or injury to my child. I understand the Grace Church adult chaperone will not be responsible for medical expenses incurred solely on the basis of this authorization. I hereby release and discharge Grace Church and all sponsors from any and all claims, demands, and actions or causes of action, past present, or future arising out of damage or injury while participating in church-sponsored student activities. I further agree to notify the student ministry pastor of any health changes that would restrict my student's participation in any normal student activities. I also understand that the student ministry leader and designated adult chaperone(s) reserve the right to restrict my student from any activity that they do not feel is within the physical capabilities of my student.

Yes, I give permission

Any thoughts or questions?

Are you in need of a financial scholarship to attend?

Yes, I am interested in a 50% scholarship Yes, I am interested in a 100% scholarship No Maybe?

Payment (Feel free to pay via Credit Card, Cash, Or Check)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

GSM Spring Retreat 2023

Description

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