Junior High Winter Retreat 2018
Register for Junior High Winter Retreat! January 26-28 at Sky Mountain.
Email address *
Student name
M/F
T-shirt size
Grade
Student cell phone
Your answer
Parent cell phone
Your answer
Address (Street, City, Zip)
Your answer
Health problems/allergies
Your answer
Dietary restrictions
Your answer
Activity restrictions
Your answer
Regular medications
Your answer
LH leaders may administer Tylenol or Ibuprofen to my child if needed
Insurance info (company, policy or group or ID #)
Your answer
Emergency contact - name
Your answer
Emergency contact - relationship
Your answer
Emergency contact - phone
Your answer
Release
I give permission for my child to participate in the 2018 Winter Retreat, and I will not hold the First Baptist Church of Davis, its members, officers, youth leaders, or those providing transportation or entertainment liable in any way for injuries attained. I permit the event staff to secure any medical treatment deemed necessary by a qualified medical examiner in case of an injury.

I also agree to permit reasonable use of photos, videos, or other images of my children and family to promote community life at First Baptist Church. I give permission to First Baptist Church for photographs and video of my child to be published (e.g. slide shows, webpages, blogs, Facebook, Instagram, Vimeo, YouTube) or posted (e.g. on bulletin boards, brochures, church calendars) by First Baptist Church.

Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms