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GPC 2016 Youth Retreat Permission Form
Berkeley Springs, WV. October 28-30, 2016.
Name of youth
Contact Number for parents
Contact email for parents
Allergies or other medical restrictions?
Medical Insurance information
Please input the name and contact number for your child's insurance, along with their medical number.
By checking this box, you give permission for your child to attend the retreat.
Yes, I give permission.
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This form was created inside of The Georgetown Presbyterian Church.
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