Winter Retreat
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Student Information
Student's Name
*
Medical/Health/Allergy Information
Parent Information
Permissions
*
Please select all that apply.
By signing my name below, I do hereby authorize the Woodstock Evangelical Covenant Church to seek emergency medical care for my child in the event of injury, accident or illness. I give my son/daughter permission to attend the youth group Hayride.
May we have permission to photograph your child?
*
Please select one option.
Yes
No
Parent's Name
*
Parent's Phone Number
*
Parent's Email
*
This address will receive a confirmation email
Emergency Contact Information
Emergency Contact 1
*
Phone Number for Emergency Contact 1
*
Emergency Contact 2
*
Phone Number for Emergency Contact 2
*
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Description
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