Staff Retreat Registration

Staff Retreat Registration

Fall 2022
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your Cell Phone
Please enter a valid phone number.
Your Email
example@example.com
Current Grade in School
Parents Names
Parents phone Number
Please enter a valid phone number.
Parents Email
example@example.com
Please Mention any medications or any dietary needs
Years Worked

202020212022
Any additional comments or questions?
Promotion/Mediacal Release

I approve of the use of pictures taken of my child to be used in promotion. In an emergency, I hearby give permission to the licensed physician selected by Sky Lodge Christian Camp to secure proper treatment,hostpital care, anesthesia, or surgery of my child named on this form.
Signature ( Parents Signature if you are under 18)

Clear
Should be Empty: