2018 PCNJ Youth Winter Retreat
* Confirmation E-Mail 을 받으셔야 등록이 잘 된 것이니 받지 못하신 분은 다시 등록해주시길 부탁드립니다. *

Date: December 26~29, 2018

Place: Spruce Lake Retreat Center, Pennsylvania (5389 Rt 447, Canadensis, PA 18325)

Theme: Freedom in Christ

Scripture: It is for freedom that Christ has set us free. Stand firm, then, and do not let yourselves be burdened again by a yoke of slavery (Galatians 5:1)

Registration Date: November 18th ~ December 1st

Email address *
Online Registration (온라인 등록원서)
Please fill out information and submit registration fee($90) to your pastor to complete registration.
Belonging Department (소속 부서) *
Participant Information (참가자 정보)
참가하는 학생 정보 (2명 이상의 자녀를 등록할 시 각각 작성후 제출해야 합니다)
Current Grade (현재 학년) *
English Name (영문이름) *
Your answer
Korean Name (한글이름) *
Your answer
Gender (성별) *
Birth Date (생년월일) *
MM
/
DD
/
YYYY
Phone Number (000-000-0000) *
Your answer
Address (집주소) *
Your answer
Sweatpants (Size) *
Allergies (알러지 정보) *
Your answer
How do you want to experience God at this retreat? *
Your answer
How can we pray for you? (Any prayer requests) *
Your answer
Parent Information (부모님 정보)
부모님 정보를 기입해 주세요
Parent Name (부모님 이름)
Your answer
Phone Number (부모님 연락처)000-000-0000 *
Your answer
Registration Fee (참가비)
Registration Fee: $90
• Please give your fees to your pastors by the deadline
• Late registration fee (additional $30) will apply if you register after December 1st
아래의 약관에 동의하신 후 교회 각 부서에 참가비를 납부해주시면 등록이 완료됩니다.
[Parental Permission & Liability Release Form] 부모님 동의서
Parental Permission & Liability Release Form (부모님 동의서)
Presbyterian Church of New Jersey
Palisades Park site: 500 Broad Ave. Palisades Park, NJ07650, Tel) 201-944-5756
Oakland site: 222 Ramapo Valley Rd. Oakland, NJ07436, Tel) 201-337-1313

NAME OF ACTIVITY: 2018 PCNJ Youth Winter Retreat

For Whom: PCNJ Palisades & Oakland Youth
Where: Spruce Lake Retreat Center (5389 Rt 447, Canadensis, PA 18325)
When: Decenber 26-29, 2018
Time: Departing time (팰팍 성전): Wednesday 10:30am
Returning time (팰팍 성전): Saturday 1:30pm
* Returning time might be changed with notice in advance.
당일 사정에 따라 도착시간이 변경될 경우에는 부모님께 미리 알려드리겠습니다.
We ask the parents to pick up their child(ren) from Palisades church.
* 부모님께서는 자녀(들)을 팰팍 성전에서 픽업해 가셔야 합니다.
Contact: 각 부서 교역자
1) 팰팍 중고등부: 김완 전도사 (347.821.9690)
2) 오클 중등부: 박찬 전도사 (201.470.0932)
3) 오클 고등부: David Chang 전도사 (845.596.0003)

As parent/guardian of my child(ren), I hereby give my permission for my child(ren) to attend and participate in the 2018 PCNJ Youth Winter Retreat sponsored by Presbyterian Church of New Jersey (“PCNJ”). I do hereby hold harmless PCNJ, its Directors, Officers, Employees, Volunteers, or Agents of said Organization, for any injury, illness or disease, or for loss or damage to any property or appliance of said child(ren). I assume the risk and financial responsibility for any injury or liability resulting from his/her participation. I authorize and permit PCNJ to furnish any necessary transportation, food and lodging for this participant. The undersigned further hereby agree to hold harmless and indemnify PCNJ, its Directors, Officers, Employee, Volunteers, or Agents for any liability sustained by said PCNJ as the result of the negligent, willful or intentional acts of said participant and of the unexpected accidents as well, including expenses incurred thereto. In the case of a medical emergency, I understand every reasonable effort will be made to contract me. In the event I cannot be reached, I hereby give permission to secure proper treatment for, and order injection or anesthesia or surgery for my child(ren) as named above. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to him/her. I consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of said child(ren) while participating in activities sponsored by PCNJ, to be used, distributed, or shown as PCNJ sees fit.

I have read the foregoing and understand the rules of conduct for participants and will abide by them as well as the directions of the leadership of the trip or activities.

If You Consent With Above, Please Click 'Yes.' (위의 약관에 동의하시면 Yes 를 선택해주세요) *
Please Write Down Your Name As An Electronic Signature. *
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A copy of your responses will be emailed to the address you provided.
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