Winter AMP
HRAC.Youth Registration Form

When: Jan 5-7 (Fri–Sun)
Where: Camp Jonah (Trout Lake, WA)
Cost: $120 per student

Participant Information
First Name *
Your answer
Last Name *
Your answer
Gender *
Birthday *
MM
/
DD
/
YYYY
Grade *
Household / Adult Primary Contact
Relation to Participant *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Zip *
Your answer
Phone *
Your answer
Email *
Your answer
Parental Consent / Insurance
I hereby release Hood River Alliance Church, its staff and sponsors, from responsibility or liability for any injury or illness sustained during this youth event. I authorize an adult leader for this activity, as agent for me, to consent to any medical treatment advised by a medical professional licensed to practice in the state where services are deemed necessary. I expect to be notified as soon as possible and services will be provided without my knowledge only in situations considered to be an emergency. *
Insurance Company (if none, put N/A) *
Your answer
Policy # (if none, put N/A) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms