2021 Spoken High School Retreat Registration
Parental/ Guardian Permission, Release, and Liability Waiver
PLEASE CAREFULLY READ ALL TERMS BELOW BEFORE SIGNING. THIS DOCUMENT AFFECTS YOUR AND YOUR
CHILD’S LEGAL RIGHTS:
Participant's Last Name *
Participant's First Name *
Date of Birth *
MM
/
DD
/
YYYY
Participant's Grade in Fall 2021: *
School Participant will be attending in the Fall: *
Participant's T-shirt Size *
Mother's Last Name *
Mother's First Name *
Mother's Cell Phone Number *
Address of Home (include City, State and Zip Code) *
Father's Last Name *
Father's First Name *
Father's Cell Phone Number *
Address of Home (include City, State and Zip Code) *
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