Junior High Winter Retreat Registration & Liability Form
This is a Mission Point Church / Oneighty Student Ministry Sponsored Event. I hereby give my child permission to participate in the Junior High Winter Retreat at the Ocean City Tabernacle on February 15-17, 2019.

Your Student's registration is not complete until a $35.00 deposit, which will be deducted from the total, has been received via PayPal at: https://mymissionpoint.com/student-ministry . Retreat Fee is $85.00 from December 20, 2018-January 3, 2019; $105.00 from January 4, 2019-January 24, 2019; $125.00 from January 25, 2019-February 7, 2019. The balance is to be paid by February 7, 2019. If you have any questions or need to pay by cash/check, please contact Rich Aspenberg at 609-338-8904 or Kerri May at 609-432-3260.

Name of Student: *
Your answer
Sex *
Grade *
Name of parent(s)/guardian(s): *
Your answer
Address: *
Your answer
Cell phone number: *
Your answer
Home phone number:
Your answer
Work phone number:
Your answer
Email Address *
Your answer
Name of Emergency contact: *
Your answer
Cell phone number of Emergency Contact: *
Your answer
Home phone number of Emergency Contact:
Your answer
List allergies or medical conditions and any medications that they are taking: *
Your answer
Is sponsor authorized to approve medical treatment? *
Is participant covered by personal/family medical insurance? *
If yes, name of insurer and policy or group number.
Your answer
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