GACS SH Spiritual Retreat Fall 2014
Senior High Retreat Permission and Medical Release Form

A successful registration will have a confirmation message at the top which is only viewable by scrolling up.  If you have any questions as to whether your child is registered for the retreat please email Sandy Johnson - sjohnson@greateratlantachristian.org

Retreat Cost:

Super Early Bird Pricing
From now until June 1 the cost is $150 for students and $190 for small group leaders

Early Bird Pricing
From June 2- August 8- the cost is $160 for students and $200 for small group leaders

Just In Time Pricing
August 9 – August 12 the cost is $175 for students. It is too late to sign up to be a small group leader after July 1.

If you want to be a small group leader, follow the link to the application at the end of this form. July 1 is the deadline to apply to be a small group leader.

The cost of the retreat will be added to student billing upon registration and will appear on your next month's statement.
For more information please contact: Mrs. Sandy Johnson, Mr. Derek Wilson, or Ms. Jessica Ly.

ADDRESS:
720 FFA-FHA Road
Covington, GA  30014
WEBSITE: georgiaffafcclacenter.org

Juniors and Seniors-  August 17-19
Freshmen and Sophomores- August 19-21

Juniors and Seniors will meet at school on Sunday, August 17 at 1:30 and return to school by 3:00 on Tuesday, August 19. Freshmen and Sophomores will leave after school on Tuesday, August 19 and Return by then end of the school day on Thursday, August 21.

PARENTS:  Please note that many students make profound spiritual decisions on this retreat. While the retreat focuses on commitment to Jesus, no high-pressure environment exists.  Of course, we are thrilled when students make deep spiritual decisions for their lives.  When you sign this form and give your permission for your child to attend, please be aware that they may choose to make a similar decision.
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Student First Name *
Student Last Name *
Student ID number *
Gender *
Student's grade level for 14-15 *
Name of Parent/ Guardian giving permission (First and Last) *
Student Email Address *
Parent Email Address *
Permission *
By checking this box, I give permission for my child to attend the GACS senior high retreat at the FFA-FHA Retreat Center in Covington, Georgia- August 18th-22nd
Required
Street Address *
Please enter the student's primary residence information.
City *
Zipcode *
Authorization and consent to disclose information, and to administer medications and medical treatment *
I give permission for GAC to dispense TYLENOL to my child. *
I give permission for GAC to dispense ADVIL to my child. *
I give permission to GAC to dispense BENADRYL (oral or topical-used for allergic reactions only) *
I give permission to GAC to dispense THROAT LOZENGES/COUGH DROPS to my child. *
I give permission to GAC to dispense TUMS/ROLAIDS to my child. *
I give permssion to GAC to dispense ANTIBIOTIC CREAM (i.e. NEOSPORIN) to my child. *
Authorization and consent to disclose information, and to administer medications and medical treatment *
By checking this box, I hereby give consent to disclose information regarding any injury or the well-being of my child to any school administrator, emergency personnel, physicians while my child is on this school trip. I hereby request that GACS, through its designated authority, assist, supervise, and/or administer the over the ounter medications indicated above to my child. Understanding that my child may need emergency treatment during this trip, I authorize the school to administer such first aid, or other minor medical treatment as shall be deemed best under the circumstance, and I consent for my child to receive such treatment. I release the school and any school employee from liability for administering any authorized medication.
Required
Date Signed *
T-shirt size *
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