CHUMY 2023 Spring Retreat

CHUMY: 2023 Spring Retreat

Apr 21-23
Child's Name:*

First NameLast Name
Birth Date:*

MonthDayYear
T-Shirt Size:*
Current Grade:*
Siblings Attending:

Parent/Gardian:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:*

Emergency Contact:*

First NameLast Name
Emergency Contact Phone:*

Area CodePhone Number
Relation to Youth
Special Needs / Alergies / Concerns:

Cost & Financial Assistance

The total cost for youth attending is $75.00. Scholarships are available for youth who want to attend, but find the cost prohibitive.

Please indicate here how much you are able to pay for the cost, no questions asked. We want everyone there!

Semester T-Shirt is included for all youth who fill out their form by April 1!

Money is due by April 19th.
$75.00$45.00$25.00$0.00Other

Parental Consent

I hereby consent to let my child participate in the event CHUMY Spring Retreat 2023! It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, Chapel Hill UMC, its staff and its volunteers are hereby released from any liability.
Child's Name of Consent:*

First NameLast Name
Parent's Name:*

First NameLast Name
Date:

MonthDayYearHourMinutesAM/PM Option
By submitting this form, I give consent for my child listed above to travel to Camp Egan with Chapel Hill UMC for their Spring retreat.
Should be Empty: