W I N T E R - A D V A N C E 2020
Registration for Winter Advance 2020 Please place a parent's email address
Email address *
What school does your student attend? *
Your answer
I give my child permission to go with Cornerstone YTH to Winter Advance 2020 at Camp Watermarks( 1145 James Rivers Rd. Scottsville, VA 24590) and Wintergreen Ski Resort (Route 664 Wintergreen, VA 22958) From January 17th to 19th *
Child's First Name
Your answer
Child's Last Name
Your answer
Age
Your answer
T-Shirt Size:
Grade
Will your child be snow tubing? (This is an additional 25$ cost)
I understand the group will meet at church at 3:30 pm on Friday (01/17/20) *
Required
I understand that my child will be back to the church at approximately 6:30 pm on Sunday (01/19/20) *
Required
In the event of an emergency, I can be reached at this phone number: (preferably cell) *
Your answer
I have read over the rules with my child. I understand that if there are any discipline problems that cannot be resolved, it is my responsibility to pick up my child at the activity location. I understand that any injury taken place will not be at the expense of Cornerstone Assembly of God. (digital signature below)
Your answer
I authorize Cornerstone Youth Director Cassie Davis, or the adult activity leader to act as my agent in authorizing any/all medical treatment or hospital care if required
Please list any/ all medications (if any) your child is currently taking and will be bringing to Winter Advance
Your answer
Health insurance provider, Identification #, and Name on Policy *
Your answer
List any medical conditions and or allergies as well as physical restrictions or limitations of your child. *
Your answer
One student that my child would like to be roomed with is:
Your answer
My child is in need of a scholarship
We will be paying the $145 registration fee by:
For Online Payment
Follow the link above. Giving type: Winter Advance For the Memo: Child's Name
I confirm that all of the above information is correct, has been filled in by a parent or guardian, and agree to speak with Cassie if there are any discrepancies or concerns. (Digital Signature)
Your answer
I confirm that all of the above information is correct, has been filled in by a parent or guardian, and agree to speak with Cassie if there are any discrepancies or concerns. (Date) *
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A copy of your responses will be emailed to the address you provided.
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