2021 Summer Retreat

Summer Retreat Registration!

This will reserve your student's spot on the trip!
August 6-9, 2021

Lake Williamson

The cost is $250.
Student Name

First NameLast Name
Current Grade
Name of Parent/Guardian

First NameLast Name
Parent/Guardian Cell Number

Area CodePhone Number
Parent/Guardian E-mail
Name of emergency contact:

First NameLast Name
Emergency Contact number

Area CodePhone Number
Please list allergies or concerns we should know:
Permission to Participate, release of medical assistance, and Transportation:

I give my permission for my child to participate in Riverside Youth Group events as well as for them to be driven by the adults leading the events as needed.

I recognize that certain hazards and dangers are inherent in programs and events of Riverside Church. I acknowledge that Riverside Church has taken safety measures to minimize any risk of injury to students involved. I do hereby release and discharge Riverside Church and its pastors and adult leaders acting officially or otherwise from any and all claims, demands, actions, or causes of action on account of any injury sustained by my child during said named above activity. I hereby authorize any pastor or adult leader of Riverside Church to obtain emergency medical treatment for my child at any time during the above named activity. I understand that an attempt will be made to notify parents/guardians first. If the parents are not available, however, the youth will be taken to the emergency room at the nearest hospital as circumstances warrant.
Do you grant your student permission to participate, the release of medical assistance, and transportation as stated above?
Photo Release

I hereby give permission for Riverside Church to use any photographs or video of my child participating in events to be reproduced and utilized in promotional materials for the Church.
Do you agree with the photo release policy stated above?
Please choose a t-shirt size:
Would you like information about payment assistance for this trip?
Any additional info we should know:
Signature

Clear
Should be Empty:

Summer Retreat Registration!