Christian Chapel / Remnant Senior Trip / Summer Missions 2017

Register for the Remnant Summer Missions Trip below.

*Additional information may be required at a further date.

Student's First Name

Student's Last Name

Student's Email Address (If Applicable)

Student's Phone Number

Most Recent Grade Completed

Please enter your full address:

Street Address

City

State

Zip Code

Medical Release Information:

Student's Name

Parent / Legal Guardian Names

Street Address

City/State/Zip

Primary Phone

Secondary Phone

Relationship to Child (i.e. Mother, Father, Grandparent, etc.)

Insurance Carrier / Policy Name or Number

Comments or Medical Information?

PEOPLE AUTHORIZED TO ACT ON BEHALF OF PARENT OR GUARDIAN

I do hereby agree to release and forever wave any claim which may arise against Christian Chapel, its employees or volunteers. This waiver of rights shall be effective immediately and shall continue to be in force until my (or my child’s) return from the youth trip to Youth Camp.

This release specifically includes all claims and demands of whatever nature, actions and causes of actions, damages, costs, loss of services, expenses and compensation on account of or in any way growing out of personal injuries, illnesses, and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arise following the execution of this release.

This release expresses a full and complete release of any liability, past or future, which may be claimed against Christian Chapel, its trustees, officers, employees and any volunteers.

*Please note a student and parent/guardian signature is required prior to leaving for the Summer Missions trip.

Student's Name

I do hereby agree

Yes

No

Parent / Legal Guardian's Name

I do hereby agree

Yes

No

CODE OF CONDUCT:

1. I agree to respect the rights and property of others. I understand that neither vandalism nor stealing will be tolerated. Financial obligations that result from such behavior will be the sole responsibility of my family and me.

2. I agree to respect adult leaders and other participants.

3. I agree to demonstrate Christian values by my language and behavior.

4. I agree not to possess any drugs, tobacco, alcohol, fireworks, matches, cigarette lighters, or knives. I will not bring any illegal items, or items that would endanger people, pets, wildlife, or property.

5. I agree to dress appropriately. I understand that this prohibits short shorts, spaghetti straps, (outside of your cabin), bikinis, or any clothing that has any reference to tobacco or alcohol products.

6. I will refrain from any sexual misconduct.

7. I will leave my cell phone at home and will not bring any electronic entertainment devices (ipods, mp3 players, PSP’s, etc.)

8. I will not leave the area that the group is at unless an adult leader grants permission.

9. I will be on time and participate in all group activities.

10. I will be open to building new relationships with my peers and adult leaders.

I understand the need to agree to the above items. I realize and agree that if I do not abide by these rules, I may be sent home at the discretion of the adult leader. I will be responsible for all consequences of my behavior.

I, as a participant agree to abide by these guidelines.

*Please note a student and parent/guardian signature is required prior to leaving for Camp.

*Additional requests may be made by our hosts during the Missions Trip.

Student's Name

I, as a participant agree to abide by these guidelines.

Yes

No

Parent / Legal Guardian's Name

I, as the parent/legal guardian of this participant, agree to abide by these guidelines.

Yes

No

Questions, comments, or concerns:

*Payment will need to be made in person at Christian Chapel. Someone will be in touch with you regarding further details.

Remnant Summer Missions 2017 Registration