Knox Youth Spring Retreat 2019
Date: Friday – Saturday, May 10 – 11

Place: Camp IAWAH (304 Iawah Rd, Godfrey, ON K0H 1T0, 613-273-5621)

Cost: $75/youth but if you bring a friend (not from Knox) both of you pay $60/youth.
Financial Assistance is also available if requested.

Deadline to register is Sunday, May 5 at 12 midnight.

Departure: Meet at Knox on Friday, May 10 by 6:45pm. Departure at 7pm and carpooling to camp.
(Dinner will not be provided on Friday)

Return: Arrival at Knox on Saturday, May 11 by 9:00pm.
If you encounter any reasons for being late, please call Phil at 613-402-4228

What to bring:
• Bible
• Writing materials
• Clothes appropriate for the outdoors and indoor sports
• Bedding (blanket & pillow)
• Toiletries
• Alarm clock
• Personal items for free time (for eg. board games or books)

Optional: swim suit for polar dip

Parent / Guardian Information:
First and Last Name: *
Your answer
Mailing Address: *
Your answer
Phone # *
Your answer
Alternate Phone#
Your answer
Email: *
Your answer
Alternate Emergency Contact:
Full Name and Phone# *
Your answer
Information: Youth 1
First and Last Name: *
Your answer
Grade: *
Your answer
OHIP# *
Your answer
Does the youth have any allergies or other medical conditions that organizers should be aware of? If yes, please explain:
Your answer
Youth 2
First and Last Name:
Your answer
Grade:
Your answer
OHIP#
Your answer
Does the youth have any allergies or other medical conditions that organizers should be aware of? If yes, please explain:
Your answer
Youth 3
First and Last Name:
Your answer
Grade:
Your answer
OHIP#
Your answer
Does the youth have any allergies or other medical conditions that organizers should be aware of? If yes, please explain:
Your answer
Registration Discount and Payment
A special deal that we're offering for our youth retreat is, if you bring a friend who is not from Knox, both of you only pay $60 each for the retreat instead of $75. Please indicate below who is bringing a friend and the name of the friend. All cheques can be made to "Knox Presbyterian Church".
Name of Knox Youth
Your answer
Name of Friend
Your answer
Photos and videos may appear in display within our church and our website. Youth's names will not be posted. If your youth are in our photos, do we have your permission to use them for display? *
Medical Agreement (for youth under 18)
I understand that, while the leaders of Knox Presbyterian Church will take precautions to ensure the safety of all participants while they are at the youth retreat, I will not hold them liable for any injury or cost incurred by injury during the activities.
I acknowledge that it is my responsibility to advise Knox Presbyterian Church of any medical or health concerns of my child that may affect his/her participation in the activities.
I give permission for my child to travel by private car if necessary. I consent that, in the case of an emergency, Knox Presbyterian Church, through its employees and volunteers may secure such medical advice and services as those individuals, in their sole discretion, may deem necessary for my child's health and safety, and that I shall be financially responsible for such advice and services.

By entering my name below, I acknowledge that I have read the above and agree to the conditions.

Full Name: *
Your answer
Today's Date: *
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