Fall Retreat 2019
Register here for the Maine District NYI Fall Retreat
Email address *
Name of the student attending *
Your answer
Is the student male or female? *
Grade *
Parent/Guardian name & phone number *
Your answer
Additional parent/guardian name & phone number
Your answer
Who, other than the parents/guardians named above, is allowed to pick up your child from retreat?
Your answer
Does your child have any allergies that we need to be aware of? *
If yes, please name the allergy and treatment.
Your answer
Does your child need to take medication while at retreat? *
If yes, please name the medication as well as the dosage. All meds must be kept in original containers and passed in at registration.
Your answer
Please check the over the counter medications that we are allowed to give your child while at retreat. Medication will be given based on dosage instructions on the label.
Are there any concerns that we can address to make you or your student more comfortable at retreat? If yes, please explain.
Your answer
Church you attend or are affiliated with. *
Your answer
Please check if you agree to the following.
A copy of your responses will be emailed to the address you provided.
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