Request edit access
Big Bear Winter Retreat 2018
Please note that in order to reserve your spot you must both fill out this form and pay the $100 deposit on the church website.

*Form MUST be filled out by Parent or Legal Guardian

Name of Camper *
First and Last
Your answer
Is the student new? *
If you're NEW, did anyone invite you? Who? (we have special prizes for new students and their friends) *
Your answer
Please provide a unique username you can remember (the name you choose will be used to anonymously look up your remaining balance on our website) *
ex: ChubbySquirrel2005
Your answer
Camper Email *
Your answer
Camper Phone # *
Write "No" if camper does not have a phone
Your answer
Camper Birthday (Month, Day, Year) *
At The Time of The Trip
Your answer
Camper Grade Level *
Name of Parent or Legal Guardian *
First and Last
Your answer
Parent E-mail *
Your answer
Parent Phone # *
Your answer
Please Select Pricing Option: *
IMPORTANT - For Those Renting Equipment:
You are responsible for renting your own equipment by using the link provided on the church website (VCFconnect.org). Equipment will be picked up Friday afternoon in Big Bear and dropped off by VCF during the trip.
How Many Days are You Renting? *
Medical Authorization
In case of illness or injury, Santa Ynez Valley Christian Fellowship has permission to procure medical treatment for the aforementioned minor. I understand that Santa Ynez Valley Christian Fellowship does not provide medical insurance or reimbursement for medical fees or prescriptions and that the Parent/Guardian is responsible for any and all fees or charges arising from illness or injury that may occur to the aforementioned minor during activities with Santa Ynez Valley Christian Fellowship.
Please State any Pertinent Medical Information *
Include allergies, special dietary considerations, current medications, or special needs.
Your answer
Physician's Name *
Your answer
Physician's Phone Number *
Your answer
Family Health Insurance *
Your answer
Subscriber's Name *
Your answer
Policy Number *
Your answer
Insurance Company Address and Phone # *
Your answer
Please Note:
By submitting this form, I, the Parent or Legal Guardian of this participant, hereby give permission for my son/daughter to participate fully in the special activities stated above. I the Guardian hereby agree to hold harmless and indemnify Santa Ynez Valley Christian Fellowship, Its Directors, Employees, and Representatives from any and all liability, personal injury, sickness or death, as well as property damage and expenses of any nature which may be incurred by the participant.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms