Overnight Service Trip
Friday, April 12 (arrive at hotel by 7:00 p.m.) to Saturday, April 13 (departing for home by 4:00 p.m.)
Name(s) of Adult Participants
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Date of Birth of Adult Participants
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Name(s) of Child/Youth Participants
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Date of Birth & Grades of Child/Youth Participants
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Hotel Accommodations, please choose:
 $145 per person (single room)  $90 per person (based on double occupancy)  $70 per person (based on triple occupancy)  $60 per person (based on quadruple occupancy)  Saturday Only Rate - $35
Email
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Cell Phone(s)
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Please list for each participant: Special Accommodations / Dietary needs / Allergies / Medications
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An Emergency Contact's Name & Phone
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Health Insurance Carrier
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Policy #
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What special skills do you or your family bring to this trip?
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