4th & 5th Graders Day Away

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

By signing up my child, I acknowledge that I will be required to complete and sign a Medical Release and Liability Form, which will be sent to my email. This form includes authorization for medical treatment, permission to participate in activities, legal release and assumption of risk, responsibility for medical expenses, and liability for damages.

I acknowledge

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

Student Information

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

Student Name

Gender Male Female

Grade

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.

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

Additional Student Information

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

Student Name

Gender Male Female

Grade

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.

Is there anything else we should know about your student?

Additional Student Information

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

Student Name

Gender Male Female

Grade

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.

Is there anything else we should know about your student?

Cost and Payment Information

The cost for the 4th & 5th Retreat is $50 per student. This covers lunch and all activities at New Life Camp.

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 Haley Gray at hgray@htcraleigh.org

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

4th & 5th Graders Day Away

Description

Please Fix the Following