Staff Retreat Registration

Staff Retreat Registration

October 25 @6pm - October 27 @11am
Student's Information
Student's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Cell Phone
Please enter a valid phone number.
Student's Email
example@example.com
Student's Current Grade in School
Years Worked

202220232024
Would you like to register a second student with this form?

YesNo
Second Student's Name

First NameLast Name
Second Student's Cell Phone
Please enter a valid phone number.
Second Student's Email
example@example.com
Second Student's Current Grade in School
Years Worked by Second Student

202220232024
Would you like to register a third student with this form?

YesNo
Third Student's Name

First NameLast Name
Third Student's Cell Phone
Please enter a valid phone number.
Third Student's Email
example@example.com
Third Student's Current Grade in School
Years Worked by Third Student

202220232024
Please Mention any medications the student(s) is bringing with them, and any dietary needs if applicable
Parents' Information
Parents' Names*
Mom's Phone Number
Please enter a valid phone number.
Dad's Phone Number
Please enter a valid phone number.
Parent's Email*
example@example.com
Promotion/Medical 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(ren) named on this form.
Please list the people that your Child(ren) has permission to be picked up from Staff Retreat by and their relation to those individuals: *
Any additional comments or questions?
Signature ( Parents Signature if you are under 18)*

Clear

Staff Retreat Registration*

Staff Retreat RegistrationPlease select the number of students you registered with this form.

$30.00 Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Staff Retreat Registration

Student's Information

Parents' Information