Youth Fall Retreat 2023

First Congregational Church in Winchester

21 Church Street Winchester MA 01890

(781)729-9180
Youth Fall Retreat 2023

EVENT PARTICIPATION CONSENT AND LIABILITY WAIVER
Where: Camp Wilmot, Wilmot NH

When: Nov 10 -12th 2023

Who: Youth in grades 6-12

Cost: $85 per participant

The registration fee helps cover the cost of lodging, food, and transportation. Please do not hesitate to email Rev. Maeve Hammond (maeve.fccw@gmail.com) for scholarship information. We want to ensure everyone can attend.

Transportation will be provided from/to First Congregational Church by rental vans driven by church staff and adult chaperones.

For questions or more information please contact: Rev. Maeve at maeve.fccw@gmail.com or 269-579-4575.
PARENTS/GUARDIANS: Please complete the form below for each participant.
Name of Participant*

First NameLast Name
Participant's Email*
example@example.com
Participant's Cell Phone*

Area CodePhone Number
Does the Participant has a Youth Information Form on file with First Congregational Church?*

YesNoI don't know.
All participants must have a Youth Information Form on file with FCCW. If your youth does not have one on file, please complete the separate form which contains important medical information.
My child/youth name* has permission to attend the event described above.
I understand that every effort will be made to contact parents/guardians in the event of an emergency. In an emergency requiring medical care and treatment, I authorize any physician, hospital or other healthcare provider to give care to this minor. I also give permission for the transport of my child/youth to/from a doctor and/or hospital by a chaperone or ambulance.

I hereby agree to hold harmless the First Congregational Church in Winchester and its agents and employees from any claim for personal injury or loss of life or property arising from participation in this Event. While I understand that the First Congregational Church in Winchester will take every precaution for safety, I realize that accidents do sometimes happen. I hereby release First Congregational Church in Winchester, its staff and its volunteers from any liability should an accident occur.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent Guardian Phone Number*

Area CodePhone Number
Does your youth have any dietary allergies or restrictions?*
Will your youth need to take medications during the retreat?*

YesNo
If your youth will need to take medications during the retreat and/or has an emergency inhaler or epipen, you must complete the Medication Release Form.
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