CAC - Youth Retreat 2019 Registration and Permission Slip

June 25-26, 2019 | Please fill out this form and click submit.
Family Info

 
 
 
 
 
 
 
 
Emergency Contacts

 
 
Medical Release

Permission and Release: I give permission for my child to participate in this activity. In the event he/she is injured, I waive and release all rights to any claim for damages against the sponsor or its representatives. I further agree that any claim or dispute arising from or related to this agreement shall be settled by mediation and, if necessary, legally binding arbitration, in accordance with the Rules of the Institute for Christian Conciliation; judgment upon an arbitration award may be entered in any court otherwise having jurisdiction.

Medical Release: In the event my child suffers sudden illness, accident, or injury and neither parents nor guardians can be contacted, I give permission for any emergency treatment that is deemed necessary by a licensed physician.
Please select all that apply.
 
 
 
 
 
 
 
 
 
 
 

Description

June 25-26, 2019
Please fill out this form and click submit.