Strive for Strength Retreat
Friday, April 19, 2019 • 3:30pm - 9pm • Check in at 3:00pm
9040 High Tech Court • Elk Grove, CA 95758 • www.striveforstrength.org

Registration Fee: Includes the following: program admission, a Strive For Strength T-shirt, dinner and
dessert, and give away item.
$30* per participant - before April 1, 2019
$50 per participant - at the door

Please make checks to SASF, Strive for Strength
Registration fee must be paid in full prior to the retreat — *NO REFUNDS
Registration scholarships available on an as needed basis.

Registration

Email address *
Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Telephone # *
Your answer
Cell #
Your answer
School Attending *
Your answer
Grade in School *
Girl Scout Participant *
Troop Number
Your answer
Troop Leader's Name
Your answer
EMERGENCY CONTACT *
Your answer
Relationship *
EMERGENCY CONTACT
Your answer
Telephone # *
EMERGENCY CONTACT
Your answer
Cell #
EMERGENCY CONTACT
Your answer
Special Concerns
Your answer
Parent/Guardian Authorization *
If neither the authorized persons designated above nor I can be reached in the event of an emergency, I authorize the adults in charge at STRIVE FOR STRENGTH, Sacramento Asian Sports Foundation and staff to contact the physician listed above at my expense and for whatever treatment the attending physician recommends. I have notified “STRIVE FOR STRENGTH” and SASF and their Staff of all medical and health conditions that my daughter has had or currently has. In the event of an emergency or if the physician designated below is not available, I hereby give permission for transportation to any medical facility or hospital, and I authorize any qualified person or medical personnel to render necessary emergency medical care for my daughter/ward.
Required
Participant's T-Shirt Size *
A copy of your responses will be emailed to the address you provided.
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