Total Eclipse of the Heart Trip
This is the registration and liability/medical release form to be filled out for all the students going on the Total Eclipse of the Heart trip to Oregon!! The trips costs $50 per students and will go from Friday August 18th through Monday August 21st. We will be leaving from City Life Community Center on Friday at 12 pm SHARP (***PLEASE make sure your student eats lunch before getting to City Life, as we are not providing lunch on Friday***)!

For further questions, please contact Joe Tredik at (406) 546-4752 or email him at joe@echomissoula.com.

Packing List:
Here is a list of items that each student will need to bring for this trip!

*Sleeping Bag/Pad/Pillow
*Sunscreen
*Swimsuit
*Towel
*Clothing for 4 days (clean underwear...PLEASE)
*Deodorant
*Toiletries
*Spending Money for souvenirs or extra snacks

Registration Information:
Please fill out the questions below to register your student for the upcoming trip!
Students Gender:
Name (First, Last):
Your answer
Age:
Your answer
Students grade (going into) and School:
Your answer
Parent/Guardian Name:
Your answer
Parent/Guardian Phone Number:
Your answer
Emergency Contact (Name and Phone Number):
Your answer
Please list any special needs or allergy restrictions that we should be aware of in the space below:
Your answer
Release of Liability:
As the participant, age 18 or older, or as legal guardian in consideration of the minor’s participation with City Life Summer Events, by checking here, I release, indemnify and hold harmless City Life, Youth for Christ (YFC), and Echo Church, as well as its employees, volunteers, agents, and board of directors from any and all actions, causes of action, liability for injury, or any damages resulting from said participation and will handle any disputes through Binding Arbitration.
Required
Medical Release:
The undersigned does hereby give permission for your child to attend and participate in the City Life/YFC and Echo Summer Trips and Events. We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical ,surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.
Required
Electronic Signature Agreement:
By checking here, I acknowledge that I am the parent or legal guardian of the participant and that I have authority to sign this form on their behalf (or that I am the participant, and am at least age 18)
Required
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