HSM Fall Retreat 2018
HSM Fall Retreat is a High School weekend retreat at Little Galilee Christian Camp. This will be a laid-back weekend of worship, group discussions, solo time, group activities, and lots of time for naps. We plan to leave the church on October 26th at 5pm and return on the 28th around noon. If you have any questions about HSM Fall Retreat, please contact Garrett LeVault @ (217) 415-5677 or garrett@mtpulaskicc.org.
Student Name *
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Grade *
Student Cell Phone (If Applicable)
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Parent/Guardian Name *
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Parent/Guardian Phone Number *
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Parent/Guardian Email Address *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Relationship to Child *
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Student's Allergies *
If your child is not allergic to anything, please write "NONE" in the space below.
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Student's Prescriptions *
If your child is not taking prescription medications, please write "NONE" in the space below.
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Is there anything we should know about your child before they attend Fall Retreat?
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Permission Statement
By typing your full name below you are hereby giving your permission that the child in your care named above attend HSM Fall Retreat with Mt. Pulaski Christian Church at Little Galilee Christian Camp on October 26-28, 2018. You are also verifying you have an up to date Liability and Media Release Waiver on file with the church. If you have not done that you can do so by visiting www.mtpulaskicc.org/safe or if you would like to find out if you have one of these on file, please send an email to garrett@mtpulaskicc.org. If you have any questions about HSM Fall Retreat, please contact Garrett LeVault @ (217) 415-5677.
Parent/Guardian Electronic Signature (Please Type Your Full Name) *
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