Fall Retreat 2024 Registration

Parent/Guardian Information

Please fill out the information below.

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Emergency Contact Name

Emergency Contact Phone

AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR I/We, the undersigned parent(s) or lawful guardian(s) of minor(s) listed above, authorize Holy Trinity Anglican Church to serve as my/our agent for determining the need of, and for authorizing, any diagnosis, treatment, and medical care (including, but not limited to determining the type of health care professional and hospital care needed) determined by Holy Trinity Anglican Church to be advisable during the trip named above. I/We understand this authorization is given in advance of any specific diagnosis, treatment or medical care being required, and is given to provide authority and power on the part of Holy Trinity Anglican Church to give specific consent to any and all such diagnosis, treatment or medical care that the health care professional in the exercise of his or her best judgment may deem advisable. LEGAL RELEASE In consideration of Holy Trinity Anglican Church determining the need for, and type of, diagnosis, treatment, or medical care (if any), I/We release Holy Trinity Anglican Church from any and all liability whatsoever for bodily injuries, property damage, or other claims sustained during or related to the diagnosis, treatment, and medical care. I/We also agree to indemnify Holy Trinity Anglican Church and/or its agents for, and hold Holy Trinity Anglican Church and/or its agents harmless from, any and all claims or suits brought by any person or entity to the extent of any and all costs, expenses, damages, judgments, verdicts, and/or attorneys’ fees. LIABILITY FOR VANDALISM OR DAMAGES I/We agree that aforesaid minor will be held personally responsible for any vandalism, and for damages caused by negligent behavior or failure to follow retreat rules.

Agree Disagree

Photography Authorization Form I give/do not give permission for Holy Trinity Anglican Church to use photos of my student/students taken during Holy Trinity Student Ministry events in their communications, which include social media, the church website, church newsletter, and other church-generated communications materials.

Give Permission Do Not Give Permission

Would you be available to come on the retreat as a chaperone?

Yes No

Would you like to sign up to receive text updates throughout the weekend (when we arrive at the retreat center on Friday, when we're on our way back on Sunday, etc.)?

Yes No

Student Information

Please fill out the information about your son or daughter below.

Student Name

Student Cell Number (disregard if your student does not have a phone)

Gender

Male Female

Date of Birth

Grade

Student T-Shirt Size

Does your student have any allergies and/or dietary restrictions?

Yes No

If so, please list your student's allergies and/or dietary restrictions here.

Will your student need to bring and medications and/or medical devices (inhaler, EpiPen) with them?

Yes No

If so, please list your student's medications and/or medical devices here.

Is there any other information we should know about your student?

Please upload a copy of your student's health insurance card.

Upload (8MB)

Additional Student Information

Disregard if you are only registering one student for the retreat.

Student Name

Student Cell Number (disregard if your student does not have a phone)

Gender Male Female

Date of Birth

Grade

Student T-Shirt Size

Does your student have any allergies and/or dietary restrictions? Yes No

If so, please list your student's allergies and/or dietary restrictions here.

Will your student need to bring any medications and/or medical devices (inhaler/EpiPen) with them? Yes No

If so, please list your student's medications and/or medical devices here.

Is there anything else we should know about your student?

Please upload a copy of your student's health insurance card.

Upload (8MB)

Additional Student Information

Disregard id you are only registering one or two students for the retreat.

Student Name

Student Cell Number (disregard if your student does not have a phone)

Gender Male Female

Date of Birth

Grade

Student T-Shirt Size

Does your son or daughter have any allergies and/or dietary restrictions? Yes No

If so, please list your student's allergies and/or dietary restrictions here.

Will your student need to bring any medications and/or medical devices (inhaler, EpiPen) with them? Yes No

If so, please list your student's medications/medical devices here.

Is there anything else we should know about your student?

Please upload a copy of your student's health insurance card.

Upload (8MB)

Cost and Payment Information

The cost for the Fall Retreat is $230 per student. This covers transportation, lodging, meals, and all activities at the retreat center.

Please select the total number of students you are registering below.

We don't want cost to prohibit anyone from coming. Scholarships are available for anyone who may need one. Please check "Request Scholarship Information" to receive more details about scholarship opportunities.

If you have any questions about the retreat cost or registration form, please email Matt Desmarais at mdesmarais@htcraleigh.org.

Afterwards, click "submit" on the bottom of the page to continue to payment information.

Please select the number of students you are registering for the retreat.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Fall Retreat 2024 Registration

Description

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