Registration for Gracepoint's 2019 Churchwide Retreat
5/24-5/26 at Warehouse Hotel in Manheim, PA
First Name *
Your personal name.
Your answer
Last Name *
Your family name.
Your answer
Gender *
Age *
Please make a registration for each child as well with specific age(s).
Your answer
Street *
Street address or post office box.
Your answer
City *
Your answer
State *
State or province.
Your answer
ZIP or postal code.
Your answer
Phone # *
Phone # where you can be reached at (in case of emergency). Your information will be held in privacy unless authorized by you.
Your answer
Email *
Your information will be held in privacy unless authorized by you.
Your answer
Only answer if you are registering from another church besides Gracepoint.
Your answer
Birthday *
Date of Birth
Your answer
Health Insurance Company *
Healthy Insurance Company (e.g. Blue Cross, etc.)
Your answer
Health Insurance Policy # *
Health Insurance Policy # in case of emergency
Your answer
Any known allergies, medications, etc. *
Any known allergies, medications, etc. that need to be konwn by the staff.
Your answer
Any special needs *
Any special needs the staff may need to be made aware of.
Your answer
Registration Fee *
NOTE: Please note for meals only SAT Breakfast is included.
Liability Release Form
I, being 18 years of age or older, do for myself (and for or on behalf of my child participant, if said child is not of age or older) do hereby release, forever discharge and agree to hold harmless Gracepoint Church’s Memorial Day Weekend retreat, and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child participant that occur while said is participating in the above described trip or activity.
Furthermore, I (and for or on behalf of my child participant, if under the age of 18 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.
Further, authorization and permission is given to said trip and travel organizers to furnish and hereby release liability of transportation, food and lodging for this participant.
The undersigned further hereby agrees to hold harmless and indemnify said organization(s), its directors, employees and agents, for any liability sustained by said travel organizers as the result,of negligent, willful or intentional acts of said participant, including expenses incurred attendant thereto.
If under age of 18 - I (we) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission for him/her to participate fully in said event and hereby give our permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any/
Further, should it become necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) hereby assume all transportation costs.
Agreement to Liability and statement of faith *
By typing in your name below, you are in agreement with the liability release form as well as the statement of faith.
Your answer
Date you're filling in this form *
Please enter in today's date in agreement with the liability release form.
Your answer
Please click the "Submit" button below to send us your responses.
You have three payment options (only choose one):
1) Cash
2) Check (made payable to "Gracepoint Church")
3) Venmo (

Let's pray it be a good time of fellowship, unity, and refreshment for the sake of His glorious body

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