2017 Student Winter Retreat // Dec 8-10
We will be partnering with Cedar Creek Baptist Church (CCBC) for a two-night winter retreat! The bulk of the retreat will be held at CCBC, with students staying in host homes of members from Fellowship.

The retreat will cost $35 (early-bird discount) through 11/19 and $50 after that. This price includes food, a t-shirt, recreation, and a thirty-day devotional that follows-up with the curriculum. Students need to arrive with their bags at Portland Christian no later than 5:00 PM on the Friday, Dec. 8th.

Please make checks payable to "Fellowship Church Louisville." Payment must be submitted to Garrett Davis before 11/19 to lock-in your early-bird rate.

If you have any questions, please feel free to call or text Garrett at (859) 553-4418 or email garrettdavis@fellowshiplouisville.org.

Student Information
Student Name (First and Last) *
Your answer
Date of Birth *
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Grade *
Street Address *
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Student Cell Number (optional)
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Student Email Address (optional)
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Parent Information
Parent Name *
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Parent Cell *
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Parent Email *
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Medical Information
Primary Care Physician
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Physician's Phone #
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Insurance Provider
Your answer
Policy Number
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Does your student have any condition or illness that would prevent their full participation in any physical activity? *
If yes, please explain in detail here
Your answer
Does your student have any food related allergies? *
If yes, please explain
Your answer
Is your student dependent on an albuterol or rescue inhaler? *
Does your student have any of the following conditions? *
Required
If your student takes medications, is he/she able to manage his/her own medication? *
Release & Waiver
I give consent for my student to participate in the “Winter Retreat” with Fellowship Church and Cedar Creek Baptist Church. I do not hold Fellowship or CCBC volunteers, associates, or any of their subsidiaries liable for any injuries, accidents, or illnesses incurred during the event.

I understand I am responsible for the expenses of my student’s medical care and that my family insurance is primary.

I further give my consent for my child to ride in any vehicle the sponsors may designate.

I understand that I am responsible for my child’s transportation to and from the location of the event, even though Fellowship has provided transportation.

I also give my permission for my student’s photo to be used in Fellowship and/or CCBC flyers, their websites, or advertisements produced by Fellowship and/or CCBC.

I have read the release and give my student permission to participate in the Winter Retreat. *
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Electronic Signature *
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Date *
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