Winter Retreat
Location: Bonita Park
Date: Jan 2-4, 2019
Cost: $150.00 per person (Hoodie included)
A $50.00 Non-refundable deposit is due at registration.
Deposit and paperwork are required to hold your spot.
Slots are limited. It is a first come, first serve event.
Final balance and all forms are due by the Dec. 9 to guarantee a hoodie.
If spots are available, you may register after Dec. 9. However, hoodies are not available.
Scholarships are available, through upcoming projects.
Email address *
Parent's Name
Your answer
Child's Name
Your answer
Please list any ALLERGIES, DISABILITIES, or RESTRICTIONS and notify your Group Leader
Your answer
Address
Your answer
Phone
Your answer
Date of Birth
MM
/
DD
/
YYYY
Hoodie Size
Grade
Father's Name
Your answer
Father's Contact #
Your answer
Mother's Name
Your answer
Mother's Contact #
Your answer
Family Doctor
Your answer
Dr's #
Your answer
Is your student allergic to any medications?
If yes, list medical allergies
Your answer
Is your student taking any medications?
If yes, list medications
Your answer
Is your student allergic to any foods?
If yes, list and to what degree
Your answer
Name of Person to Contact if Unable to Contact Parent
Contact 1
Your answer
Contact 1's #
Your answer
Relationship(1)
Your answer
Contact 2
Your answer
Contact 2's #
Your answer
Relationship(2)
Your answer
Upon submission of this form, your child has chosen to participate in Bonita Park Camp and Conference Center and/or Angus Nazarene Church activities, and related events. You understand that participation in these activities is not without risk. You have carefully read this agreement and understand its contents. This liability release and indemnification agreement shall be legally binding upon your heirs, assigns, legal guardians, personal representatives and yourself. You are aware that you are releasing certain rights that you otherwise may have of your own free will. *
Upon submission of this form, you (the Parent/Guardian) give permission for your child to attend and participate in the activity/event listed above. You also give your permission for any adult sponsor on the trip to authorize medical treatment should treatment be necessary. You understand that as a Participant, you or your student may be photographed or videotaped during normal camp or event activities and these photos/videos may be used in promotional materials. *
Once this form is submitted, you will receive an email of your answers, along with a link to PayPal to make the required $50 deposit reserving your spot.
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