Upper Elementary Upper Elementary Retreat Where: Skycroft Conference Center When: June 7th to June 9th Cost: $140 per participant ($240 for 2 Siblings) Deadline for registration: May 15th Parent / Emergency InformationParent/Emergency contact Name(Required) First Last Parent/Emergency contact Email(Required) Parent/Emergency contact Phone(Required)How many kids are you registering?(Required) One Two Child InformationChild Name(Required) First Last Child Grade(Required)Please choose oneThirdFourthFifthChild T-shirt size(Required)Please choose oneSmallMediumLargeX-LargeIs the child allowed to use the pool ?(Required) Yes No Child's Food Allergies or Medical issues First Child InformationFirst Child Name(Required) First Last First Child Grade(Required)Please choose oneThirdFourthFifthFirst Child T-shirt size(Required)Please choose oneSmallMediumLargeX-LargeIs the child allowed to use the pool ?(Required) Yes No First Child's Food Allergies or Medical issues Second Child InformationSecond Child Name(Required) First Last Second Child Grade(Required)Please choose oneThirdFourthFifthSecond Child T-shirt size(Required)Please choose oneSmallMediumLargeX-LargeIs the child allowed to use the pool ?(Required) Yes No Second Child's Food Allergies or Medical issues Health Insurance InformationPediatrician Name(Required) Pediatrician Phone Number(Required)Upload a picture of Health Insurance Card(Required) Drop files here or Select files Max. file size: 4 GB, Max. files: 2. Payment OptionPlease choose one option(Required) Pay in Full now Pay 2 installments over 2 month Pay 3 instalments over 3 month Total Amount DueTotal Registration Due Amount: $0.00 Would you like to donate to support the Ministry? Total Due Now Consent(Required) I agree to the consent belowI give permission for my child whose name is entered above to take part in the church trip described above. I hereby 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 in their best ability, I will not hold them or the Church responsible for any accident or injury. 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 Cardholder Name Card Details