Junior Elementary 2026 Retreat When: May 30th and 31st. 2026 Where: Potomac Park Retreat Center Deadline to register: April 30th, 2026 How many kids are you registering ?Please enter a number from 0 to 2.Parent / Emergency InformationParent/Emergency contact Name First Last Parent/Emergency contact Email(Required) Parent/Emergency contact Phone(Required)First Child InformationFirst Child's Name(Required) First Last First Child Grade(Required)Choose oneFirstSecondFirst Child's Food Allergies, medications or medical condition?Second Child InformationSecond Child's Name First Last Second Child GradeChoose oneFirstSecondSecond Child's Food Allergies, medications or medical condition?Payment OptionPlease choose an option(Required) Pay in Full Pay using 2 monthly payments Pay using 3 monthly payments Total Amount DueTotal Registration Due Now Price: $0.00 Donate to support the Ministry Total Due Consent(Required) I agree to the consent belowAs a parent/guardian to the child, - I give permission for my child(ren) to take part in the church trip described above. - I authorize the trip leaders to act on my behalf according to their best judgment in an emergency requiring medical attention, and I agree to take responsibility for the expense of such a procedure. I understand that while the leaders will try to act to the best of their ability, I will not hold them or the Church responsible for any accident or injury. - I give my permission for my child(ren) to be transported to and/or from the retreat by an authorized servant van/car, if needed. - I also understand that my child(ren) will NOT bring a phone, smartwatch, or any smart or internet-enabled device to the retreat. - Finally, I understand all reasonable safety precautions will be taken at all times by trip leaders during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold the Church or leaders liable for damages, losses, diseases, or injuries incurred by the subject of this form. Credit Card InformationCredit Card InformationCredit Card(Required) Cardholder Name Card Details
