Forms

Student's Name:

Current Grade:

T-Shirt Size:

Phone Number:

Street Address:

Medical Conditions:

Food Allergies:*

Emergency Contant:*

Emergency Phone #*

Insurance Company:

Insurance #:*

Parental Consent:

My Child, has my permission to go to Franklin, PA on a retreat with the High School Group from Calvary Chapel Westside. They will be gone from Monday, July 15th to Friday, July 19th, 2024. I understand there will be various games and activities as well as driving to and from the retreat. I absolve Calvary Chapel Westside and those representing the Church from any responsibility for any accident involving my child during this trip. I also authorize the leadership of the High School Group to seek any necessary medical assistance in the case of an emergency involving my child. If there is any issue with my child due to disorderly conduct or an emotional need to come home, I agree to come or send someone to take them home after I am contacted.  

Parent / Guardian:

Date: