Student's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

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Liability Waiver *

By checking this box, the parent/guardian agrees not to hold Evangelical Presbyterian Church or its employers or volunteers liable for damages, losses, or injuries to the child and/or their property. The parent/guardian understands that by checking this box they are acknowledging this statement for the minor listed on this registration form.

I Agree

Code of Conduct Agreement *

By checking this box, the student agrees to abide by Evangelical Presbyterian Church’s code of conduct for the retreat. The code of conduct involves acting as is becoming of a Christian and includes, but is not limited to, respecting others, wearing decent clothing, not distracting oneself or others during teaching time, and refraining from all profanity, gossip, and insults. Students who do not abide by the code of conduct may lose certain privileges of the retreat.

I Agree