MS Spring Retreat @ Piney Woods Camp!
April 21-23, 2017 | $150
Drop off at FPC at 6:15 pm | Eat dinner before you come! | Pick-up at noon on Sunday at FPC
Last Name of Student *
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First Name of Student *
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Gender *
Grade *
School *
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Parent Email Address (primary) *
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Parent Email Address (secondary)
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Mother's Cell # *
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Father's Cell # *
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Student's Cell # *
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Emergency Contact (if parents can't be reached) *
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Emergency Contact # (if parents can't be reached) *
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Medical Insurance Provider *
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Medical Insurance Phone # *
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Medical Insurance ID *
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Medical Insurance Group # *
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List any allergies or medical conditions: *
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I hereby give permission for my child to attend the FPC MS Spring Retreat at Pineywoods Baptist Encampment from April 21-23, 2017, riding as a passenger in church rented bus or van. I also give permission for any member of the FPC Youth Team, in the event of an emergency, to seek dental &/or medical attention necessary for my child. *
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