Freedom Youth One Day Retreat - May 18

Youth Member #1

Name

This address will receive a confirmation email

Youth Member #2

Name

This address will receive a confirmation email

Youth Member #3

Name

This address will receive a confirmation email

Parent/Guardian

Parent/Guardian Name

Address

This address will receive a confirmation email

Emergency Phone Contact

Parent/Guardian for Under 18

I, the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in the Freedom Youth Retreat. I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize Isabelle Rossiter to aid in and/or find a medical professional to provide any necessary medical services in the event that my youth is injured or becomes ill.

Medical Information

Health Insurance Company

ID#

Group ID#

Description

May 18 10am-4pm

Freedom Youth Retreat
@ Freedom Hope Church

Freedom Youth One Day Retreat - May 18

Description

Please Fix the Following