4th/5th Grade Retreat 2023

A Children’s Ministry Retreat sponsored by churches in the North Georgia Conference at Indian Springs State Park Group Camp (Flovilla, GA) for kids in 4th and 5th grades. The weekend will be filled with fun, fellowship, worship and specific activities especially for 4th/5th graders as we dig into God's Word to discover what it means to be a Disciple of Christ! Join us for a weekend you won’t want to miss!

COST: $110.00 (Includes registration, meals & snacks on Saturday & Sunday, transportation, T-Shirt and all activities)

DEADLINE: $60 due by February 15*
(Medical Form and Balance due March 15th)

*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 catherinel@lvfirst.org.

Student Name*

First NameLast Name

Birth Date*

MonthDayYear

Current Grade*

T-shirt Size*

Allergies, Medications or Info we should know:

Do you need to register another student?

No, I'm done!Yes, please!

Student 2 Name*

First NameLast Name

Student 2 Birth Date*

MonthDayYear

Student 2 Grade *

Student 2 T-shirt Size*

Student 2 Allergies, Medications or Info we should know:

Parent/Guardian Name*

First NameLast Name

Phone Number*

Area CodePhone 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 UMC 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*

Date

Time*

:HourMinutesAM/PM Option

4th/5th Grade Retreat 2023

STUDENT INFORMATION:

STUDENT 2 INFORMATION:

PARENT/GUARDIAN INFORMATION: