White Earth Mission Trip: Participant Release Form 2017
White Earth Mission Trip: July 29 - August 5, 2017
Lodging is at:
Youth Hostel at Itasca State Park (3:40 minute drive)
27910 Forest Lane, Park Rapids

Please fill out one form for every participant.

Participant's Name
Your answer
Age
Your answer
Grade in Fall of 2017
Your answer
Birthdate
MM
/
DD
/
YYYY
Parent / Guardian Name
Your answer
Home Address
Your answer
Phone Numbers
Please list all numbers, in order that should be called and indicate which are land line's or cell phones.
Your answer
Email Addresses
Please list all addresses and the name that each belongs to.
Your answer
Emergency Contact
Please list name(s) and phone number(s)
Your answer
Best Way to Contact / Communicate With Your Family
Transportation Needs
White Earth Mission Trip is from July 29 to August 5, inclusive. Please check all transportation needed.
Dietary Needs
Your answer
Allergy Needs
Your answer
Medications
Please list name of medication and prescription directions.
Your answer
Other Needs That Are Important For Us To Know
Your answer
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