Gospel Life December 27, 2018 2018 Youth Winter Retreat Gospel Life December 27, 2018 View fullsize Download Registration Form here REGISTER ONLINE 2018 YG Winter Retreat Registration Student 1 * First Name Last Name Student 2 First Name Last Name Parent/Guardian First Name Last Name Phone, Email * Additional Emergency Contact First Name Last Name Phone Medical Information Does your child have any allergies or special medical needs? (medication, condition, etc). Please describe. Health Insurance Company and Policy/Group Number. LIABILITY RELEASE AND PERMISSION FOR MEDICAL TREATMENT By checking here, I agree to all terms below. My name below serves as my electronic signature. I, parent or guardian of the student(s) named above, a minor, do hereby authorize adult leaders of Korean Presbyterian Church of Baltimore as agent(s) to consent to medical care deemed advisable by an accredited physician or surgeon in an approved emergency clinic or hospital if I am not able to be reached. I further release from any liability Korean Presbyterian Church of Baltimore, any of its leaders in the event of an accident during Winter Retreat, from December 27th to December 29th of 2017. I agree that my child will be expected to abide by the rules of the activity above. I understand that if my child behaves in a way that may bring harm to self or others or if my child behaves in a way that hinders others from participating in the activity, my child may be sent home. Thank you!
