2026 Youth Fall Retreat

Parent/Guardian Information

Parent/Guardian #1 Name

Parent/Guardian #1 Email

This address will receive a confirmation email

Parent/Guardian #1 Phone

Address

Parent/Guardian #2 Name

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

Child(ren)/Youth Information

School District

Child #1

Child #1 - First and Last Name

Child #1 Birthdate

Current Age or Grade - Child #1

Child #1 Allergies, special needs, medical conditions, etc. Insurance Provider and policy and ID #.Please list below:

Attendance

Child #2

Child #2 First and Last Name

Child #2 Birthdate

Current Age or Grade Child #2

Child #2 Allergies, special needs, medical conditions, insurance policy and Id #, etc. Please list below:

Attendance

Child #3

Child #3 First and Last Name

Child #3 Birthday

Current Age or Grade Child #3

Child #3 Allergies, Special Needs, Medical Conditions, insurance policy and ID #, etc. Please list below:

Attendance

I can help chaperone or stay overnight or can be a driver. Select all that apply.

No Maybe Friday driver and Friday evening Friday overnight Saturday Day Saturday evening Saturday Overnight Sunday morning driver

Acknowledgements, Permissions, & Medical Release

I give Family of Christ permission to take photography and/or video of my child(ren) while participating and use photos/videos for promoting Family of Christ programs.

Yes No

I grant permission to Family of Christ Lutheran Church personnel to seek emergency medical treatment for my child(ren) should it be needed. I understand they will make every reasonable effort to contact me or the emergency contact I provide on this form.

Yes No

By checking this box I am giving my permission for attendance to Family of Christ's Fall Youth Retreat, Oct. 2nd, 3rd, and 4th. In the event that I cannot be reached in an emergency, I hereby give permission for the leadership of my church personnel to have an authorized doctor or medical professional, hospitalize, administer medical aid and treatments, order injections, anesthesia, or surgery for my child at any time they believe an emergency exists. I will be responsible for all medical bills. I agree to not hold Family of Christ, Camp Spring Lake Park, or the leaders responsible for any accident, should one occur.

Yes No

I agree to all of the above and therefore sign this form.

Yes No

Any comments, suggestions, or other information we should know.

Suggested Donation

Fall retreat fee is $30. You can bring a check, written out to Family of Christ, or use the link on the confirmation email with the Vanco link. There will also be a sign-up genius to help with some of the food.

2026 Youth Fall Retreat

Description

Please Fix the Following