Camp Glisson Children's Retreat 2022

3rd - 5th Grade Fall Retreat 2022

Friday, September 16 - Sunday, September 18 at Camp Glisson
We are so excited to be returning to Camp Glisson for the NGUMC Children's Retreat - an experience designed specifically for 3rd - 5th graders! We will leave the church on Friday around 5:30p and return Sunday at around 1p.

COST: $150.00
(Includes registration, meals, transportation and all activities)

DEADLINE: $50 deposit due by July 25th*
(Balance due August 25th)

*There are limited spots available that will be filled in order of receipt.

For questions, more information or scholarship request please contact Catherine Lombard at clombard@fumclv.org
STUDENT INFORMATION:
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Grade Fall 2022 *
Allergies, Medications or Info we should know:
Do you need to register another child?

No, I'm done! Yes, please!
STUDENT 2 INFORMATION:
Student 2 Name

First Name Last Name
Student 2 Birth Date

Month Day Year
Student 2 Grade Fall 2022
Student 2 Allergies, Medications or Info we should know:
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Additional Contact and Phone Number
Name and Cell Number
ADULT CONSENT:

My child has my permission to participate in the above activities including being transported in a church bus for the above purposes. Children's Ministry Staff and Designated Chaperones have my consent to seek medical treatment in an emergency or in the event that I cannot be contacted.

I further grant permission to LV|first to use photographic images or video recorded footage of my student for Children's Ministry promotional purposes.

I understand that although the students will be supervised by approved church staff and volunteers, I do assume the risk of my student’s participation in the event. I acknowledge that I will not seek to have the Church held liable in the event that any accident, injury, loss of property or any other circumstance or incident occurs during or as a result of my son’s/daughter’s participation in this event. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from participation in the event. I hereby release and agree to hold harmless the Church, its chaperones, and employees, from any claims arising out of my son’s/daughter’s participation in the event(s).
I have read and accept the terms above *
Please type your full name
Date *

Month Day Year
Date
Time *

: Hour Minutes AM/PM Option
Should be Empty:

3rd - 5th Grade Fall Retreat 2022

STUDENT INFORMATION:

STUDENT 2 INFORMATION:

PARENT/GUARDIAN INFORMATION: