February 2020 Youth Event Registration

Presbytery Youth Retreat Registration Form

Instructions Please answer all of the questions below. You will need to submit a registration form for each student attending the event.

Student Info

Name *

Date of Birth *

Gender *

MaleFemale

Parent/Guardian Name *

Email Address *For form confirmation and email updates about camp.

Phone Number *

Emergency Contact

Name *

Relationship *

Phone Number *

Payment Options *
Cash
The cost of the event is $10 per student plus the cost of mini golf: $11 for under-16s and $15 for 16s and over.

Other information

Medical Alerts / Allergies & Reactions (Please give specific details)

Current Medications (if any)

Dietary Requirements (Please give specific details)

Comments

Feel free to send through any comments or questions you may have.

Consent

I give permission for the above named to attend the RPCA Youth Event in Geelong on the 22nd of February 2020.

I understand that all reasonable safety precautions will be taken at all times and that the leaders and those connected with the group cannot be held responsible for personal injury, loss or damage incurred by the subject of this form.

I understand that if urgent medical attention is needed, that every effort will be made to contact the persons listed on this form. In the event that I cannot be contacted in an emergency, I give my permission for my child to receive such medical treatment as the leader may deem necessary and I agree to meet the costs of such assistance.

I hereby give permission for the above named to travel by private transport to and from the Reformed Presbyterian Church Geelong. I understand that all drivers will be fully licensed and hold a current WWCC.

Parent / Guardian Name to Affirm Above *

Today's Date (dd/mm/yyyy) *

Verification

Please enter any two digits (to make sure you're not a robot) *Example: 12
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