Youth Fall Retreat 2024

Student Information

Name

Gender

Male Female

Grade

Address

Shirt Size (Adult Sizes)

Parent Information

Parent or Guardian Name

This address will receive a confirmation email

Phone

Release

I consent to my youth’s participation in the above stated activity. I understand and agree that neither Immanuel, nor its trustees, staff, or volunteers may be held liable in any way for an occurrence in connection with the stated activity which may result in harm, injury, or other damages to the undersigned, the youth listed above, or guests, invited or not. I give my consent for Immanuel Youth Ministries Staff and Volunteers to take my youth, listed above, on the stated activity including transportation in church-obtained or personally-owned vehicles. I give my consent to Immanuel Youth Ministries Staff and Volunteers and/or qualified medical personnel to act on my behalf in securing and administering necessary emergency medical treatment for the above named youth. I give my consent for my child to be shown in photos and videos. These photos and videos may be used to share about the trip and/or promote Immanuel’s ministries.

I agree to the waiver/liability statement

Payment

Select your payment options below. You may pay the full amount by card with the submission of this form, or pay later by cash or check in-person through the offering on Sunday mornings or through the church office.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Youth Fall Retreat 2024

Description

Please Fix the Following