Youth Winter Retreat 2024

Connection Youth Winter Retreat 2024

March 1-3, 2024
Cost: $115 / student

Students in grades 6-12 are invited to join us for an exciting weekend full of fellowship, small groups, games, activities and more! This year we will travel north to the Black Rock Retreat Center in Quarryville, PA where we will stay from Friday evening through Sunday afternoon. Lodging, meals and transportation are included in the $115 / person cost. Registration begins Nov 19, and there are a limited number of cabin spots, so sign up soon!

Registration Information

Student Name

Parent Name(s)

Address

Parent Email

Parent Phone

Student Email

Student Phone

Grade

School

Date of Birth

Emergency Contact Information

2 are required

Name

Phone

Name

Phone

Insurance Information

Medical Insurance

Medical Conditions or Allergies

Medications

Other medical/emotion information

Consent and Travel Waiver

PHOTO

I understand that photos of my child may be taken as part of program participation. I consent to use of photos/videos of my child in standard promotional materials via print or online.

Initial

TRAVEL

I understand that activities will be conducted offsite at pre-disclosed destinations. I consent for my child to travel in program-provided transportation each day and release liability for all incidents related to standard travel risks.

Initial

ACTIVITIES

I consent for my child to participate in the scheduled daily activities and attest to his/her mental and physical ability to safely engage in scheduled programming. I understand that there are risks associated with said activities – including the potential for sickness, accidents and injuries – and waive liability of Connection Community Church and program leaders for any such occurrences.

Initial

MEDICAL

In the event of an emergency, and if I cannot be reached, I give my consent for program leaders to authorize emergency medical help onsite or at an appropriate medical facility.

Initial

CONDUCT

I understand that students are expected to conduct themselves with respect for others at all times, and that they must follow stated guidelines for safety at each location. I understand that students who do not follow safety rules – such as staying with the group and checking with leaders – may be asked not to return for remaining activities. In extreme cases, students who are not adhering to rules or who are creating significant disruptions may be dismissed early in the same day with a phone call to the parent/ guardian.

Initial

Student Name

Parent/Guardian (Print)

Parent/Guardian Signature

Date

Payment Options

Pay Now (Online)

Pay Later (Cash/Check)

Comments

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Connection Youth Winter Retreat 2024

Registration Information

Emergency Contact Information

Insurance Information

Consent and Travel Waiver

PHOTO

TRAVEL

ACTIVITIES

MEDICAL

CONDUCT

Ministries

Connect

Watch/Listen

Give Online