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4th & 5th Grade Retreat-2025 - Victory Ranch

April 25, 2025 - April 27, 2025

*Per our policy, refunds are only given for family and/or medical emergencies.

*If paying online, the cost is $190. If paying by check, the cost is $185. Your child's spot is not guarunteed until payment has been received. 

For more infomation about the Retreat, graceevan.org/amaginggraceland.

Additional Options

$190.00  Online Payment
   Price is $185 if paying by check.

Registrant Information

Child's First Name*
Child's Last Name*
Email*
Full Address*
Gender*
Grade*
Date of Birth*
Parent(s) Name(s)*
Mom's Cell #*
Dad's Cell #*
T-Shirt Size*
Emergency Contact Name*
Emergency Contact Phone #*
Family Insurance Carrier*
Policy #*
Policy Holders' Name*
Family Physician's Name*
Family Physician's Phone #*
IMPORTANT Allergy & Medical Info*
Medication Taken During The Trip*
These medications will be available at camp. Check the ones that your child CAN take.*  Children's Tylenol
 Children's Advil
 Benadryl
 Children's Sudafed
 Delsym Cough
 Pepto Bismol
 Chloraseptic
 Do not give my child any medication
If visiting, child you are visiting with
ONE person (in my grade) I'd like to be in a cabin with
I will be available for the parent meeting Wed, April 2nd at 7:45pm*
If no, please email camille@graceevan.org ASAP to discuss options.
Can we photograph your child for use on our social media accounts and our website?*  Yes
 No

Terms & Conditions

In consideration for being allowed to participate in activities sponsored by Grace Evan Church, I hereby release discharge, indemnify and agree to hold harmless Grace Evan Church, its Elders, Staff, or other agents for any and all liability for personal injury, loss, illness, damage or accident that I might encounter in association with their ministry including but not limited to mission trips sponsored or facilitated by Grace Evan Church.

I further agree to indemnify and hold harmless Grace Evan Church, its Elders, Staff, or other agents from any claim and/or damages it, or its agents are required to pay as a result of any injury or damage including reasonable attorney fees, litigation expenses and court fees.

I am volunteering to participate with Grace Evan Church freely and without undue influence. I further acknowledge and understand that my participation with Grace Evan Church, including traveling on a mission trip whether internationally and/or domestically, includes risks and possible dangers. I am well aware that my participation also exposes me to such risks as accidents, disease, war, terrorist attacks, political unrest, kidnapping, injury and other calamities. Further I agree to hold blameless Grace Evan Church, its Elders, Staff, or other agents for any delay, cancellation or irregularity in schedules or travel plans.

I assume any such risks that might result in my participation with Grace Evan Church, including travel on mission trips, and I unconditionally agree to hold Grace Evan Church, its Elders, Staff, or other agents blameless for any liability concerning my personal health and well-being, or any liability for my personal property that might be lost, damaged, or stolen, whether such property is traveling with me or remaining, while I am participating with Grace Evan Church, including, but not limited to, traveling domestically and/or internationally.

In case of medical emergency Grace Evan Church or its agents are authorized to take such measures and arrange for such medical and / or hospital treatment as deemed advisable for my health and well-being. I accept all financial responsibilities concerning any medical emergencies. I release Grace Evan Church, its Elders, Staff, or other agents from claim or liability due to sickness or injury.

PARENTAL AGREEMENT:
I agree that my child could possibly be sent home at my expense for bring, using, or having any of the following items: alcohol, tobacco products, fireworks, or any weapons.  I also give the staff and leaders permission to send my child home at my expense for any behavior they feel is disruptive and/or inappropriate.

_______________________________________________________________________________________

MEDIA CONCENT:
As a parent or guardian of this child under 13 years old, I hereby consent to the use of photographs/videotape taken by Grace Evangelical Church for publicity, promotional purposes (including publications, newspaper, website, social media or other media sources). I do this will full knowledge and consent and waive all claims for compensation for use, or for damages.

  By checking this box, you agree to be legally bound to the above terms & conditions.

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