Arden Youth 2021 Summer Registration
Once you have completed this form please follow the link at the bottom of the page to pay. Please include your child's name and the retreat name(s) in the description box on the payment site. Your spot is not held until we receive both the registration form and the payment. Please submit a separate form for each child.

Service Outreach Week (SOW): June 14th-18th/ $50

HS Escape, Lake Chatuge: July 16th-18th/ $75

SE Middle School PCA Retreat: July 26th-30th/ $300* (extra spending money for camp store is optional)

*$50 discount is available for memorizing Psalms 2, 16, 23, 32 and 110 (47 verses)
Email *
Untitled Title
I am registering my child for: *
Required
Please fill out the form below
Student's First Name *
Student's Last Name *
Address *
City *
State *
Gender *
Birth Date *
MM
/
DD
/
YYYY
Current Grade *
SOW participants only (June 14th-18th): What is your T-shirt size?
SOW participants only (June 14th-18th): We will be tubing on Friday- do you plan to participate?
Clear selection
Father's Name
Father's Address (if different from Student)
Father's Phone
Father's Work Phone
Mother's Name
Mother's Phone
Mother's Work Phone
Mother's Address (If different from Student)
Medical Insurance Company *
Insurance Policy # *
Insurance Phone number *
Physician Name *
Physician Number *
Dentist Name
Dentist Phone
What medication(s) and/or food(s), or insects is your student allergic to?
Please list any medication(s) that your student is prescribed, and any over the counter medication(s) to include dosage and instructions.
Can your child swim? (please note that a swim test will be required for the HS retreat) *
Does your child wear glasses? *
Date of last tetanus shot? *
MM
/
DD
/
YYYY
Has your child been treated by a physician or hospitalized in the last year? *
If yes, please describe hospitalization
Is your child receiving counseling?
Clear selection
If yes, please describe counseling
Describe in detail the nature of any physical and/or psychological ailment, illness, propensity, limitation, weakness, handicap, disability, or condition to which your student is subject and of which the staff should be aware, and what, if any action or protection is required on account thereof.
Activities may include, but are not limited to: cookouts, boating, water skiing, swimming, basketball, roller skating, soccer, broomball, rollerblading, games in the park, ice skating, volleyball, softball, baseball, camping, downhill skiing, snowboarding, hiking, biking, concerts, Bible studies, golfing, hayrides, and miniature golf. NOTE: If you desire to limit your student’s participation in any activity, please submit your wishes in writing to the youth pastor prior to that activity. *
Required
Medical Release & Permission Form: The student has my permission to attend all youth activities sponsored by Arden Presbyterian Church, 2215 Hendersonville Road, Arden, NC 28704 (hereinafter “the Church”). This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church and its staff of any liability against personal losses of named student. I/We the undersigned have legal custody of the student named above, a minor, and have given my/our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our student’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event the treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/We also agree to bring my/our student home at my/our own expense should he/she become ill or if deemed necessary by the student ministries staff members. *
Required
Media Release: I grant permission to Arden Presbyterian staff or designee(s) to use photos/videos of my child(ren) taking part in the trips and activities. *
Are you a member of Arden Presbyterian Church
Clear selection
After submitting this form, I agree to pay the cost at https://www.ardenpres.org/give-online Please remember to put your child's name and the name of the retreat in the description box.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy