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GPC 2016 Youth Retreat Permission Form
Berkeley Springs, WV. October 28-30, 2016.
Name of youth
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Parent(s) Name(s)
Your answer
Contact Number for parents
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Contact email for parents
Your answer
Allergies or other medical restrictions?
Your answer
Medical Insurance information
Please input the name and contact number for your child's insurance, along with their medical number.
Your answer
Other comments
Your answer
Permission
By checking this box, you give permission for your child to attend the retreat.
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