GA NYI Fall Retreat | Student Registration
Use this form to register a student (grades 6-12) for the Georgia NYI Fall Retreat. The Retreat will be held at the FFA Campground in Covington, GA and will be November 17 - 19, 2023
Registration Costs and Deposit
Your Registration Cost is based on the postmarked date of the deposit check sent by the church you are attending with (see below). The cost scale is as follows:Deposit at all levels: $50 (Non-refundable, but transferable)Cost if postmarked by:- October 22 $180. October 23 - November 5th: $190 November 6 - November 10th $200. after November 10th: $210
Registration Policy
Please register as follows: 1. Complete the online registration form, including the online waiver with an electronic signature 2. Give the Deposit money to the church you are attending with, made out to that church. 3. By each registration deadline (Oct. 22, Nov 5, Nov 10) the church must send ONE check from the church made out to "GA NYI" to secure the registration price. 4. Please send payment to: Mt. Olive Church of the Nazarene ATTN: Nannette Mayo 591 Mt. Olive Church Rd. Wrightsville, GA 31096. PLEASE NOTE: your registration is not finalized until your church has mailed in a check for the deposit for the participants. Registration costs are based on the POST MARKED date of the check sent from your church. All late fees are FINAL due to the increased cost from the campgrounds.
The Rules:
- NO weapons, drugs, tobacco, vape products, alcohol, fireworks, or gaming systems- Be respectful of other people and property- Modest clothing at all times- No one is allowed out of their cabin after curfew
I have read and understand the new registration policy for the GA NYI Fall Retreat
*
Yes
Need Help?
If you need any help registering, or have any questions about the process, please contact our team at georgiafallretreat@gmail.com, and you will receive an answer within 24 hours.
GA NYI Fall Retreat - Student Registration
Use this form to register a student (grades 6-12) for the Georgia NYI Fall Retreat.
Student First Name
*
Student Last Name
*
Home Address
*
City
*
Home Phone
*
Students Cell Phone
Age
*
Please Select
10
11
12
13
14
15
16
17
18
19
Curent Grade
*
Please Select
6
7
8
9
10
11
12
Gender
*
Please Select
Male
Female
T-Shirt Size (adult)
*
Please Select
Small
Medium
Large
XLarge
2XLarge
3XLarge
Church You are Attending With
*
Medical and Insurance Information
Please provide as much detail as possible when completing allergies and medical needs. Please know that we will NOT be collecting medications, and that each church will be responsible for making arrangements with a responsible adult leader to oversee the distribution of prescription medication. We will have a Camp Nurse available for minor injuries and non-prescription medication distribution as necessary (e.g. antacids, Tylenol, Benadryl, etc.)
Date of Last Tetanus Shot (an approximation is acceptable)
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-
Month
-
Day
Year
Date
Does the camper have any medical needs or allergies?
*
Please Select
Yes
No
If Yes to the above, please describe:
Will the camper be taking any medication?
*
Please Select
Yes
No
If Yes to the above, please list the medication, frequency, and dosage:
Insurance Company
*
Policy #
*
Is there any other information that would assist the Retreat Director and Nurse?
Emergency Contact
In the event of either a medical emergency or a failure to abide by the expectations and Camper Covenant, we need the best emergency contact.
Full Name
*
Relationship to Camper
*
Cell Number
*
Additional Phone Number
Comments:
General and Medical Release
Please read the following General and Medical Release statements and complete the electronic signature below.
General Release
I/We, (parent’s name) after careful consideration, give permission for my/our child/ward, to participate in the Georgia District Church of the Nazarene (hereinafter “District”) sponsored Fall Retreat, to be conducted from November 17 -19, 2023. I/We are aware of the purpose and scope of this event. I/We recognize that it is an extraordinary church function and accept responsibility for the general and normal risks involved in this activity. Therefore, in consideration of the District permitting my/our child/ward to participate in this Event, I/We release the District, their respective members, offers, directors, subcontractors, employees and/or agents of liability for any injuries and/or losses which may occur or arise out of (whether directly or indirectly) by way of our child’s/ward’s participation in such activity, except those caused by willful, wanton, reckless, or malicious actions of said District and their respective members, offers, directors, subcontractors, employees and/or agents. I understand the event may include several campus activities.
Damage Release
I/We further accept responsibility for my child’s/ward’s actions and agree to be financially liable for any damages resulting from unacceptable behavior.
Photo Release
By signing this consent form, I/We give permission to the District for any photos or videos taken of myself or my child/ward for the duration of the event, and that they may be used at the discretion of the District for promotional purposes.
Medical Relase
If it is necessary for my/our child/ward to receive medical, surgical, or dental care administered, I/we give permission for the trip leader to authorize care for my child/ward for the period of the activity as a part of the event.
I have thoughtfully read and understand the above General, Damage, Photo, and Medical Release Statements
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Yes
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Release Statements.
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Yes
I have understand that I will be providing, as proof of identity, the last four (4) digits of my Social Security Number
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Yes
Signature of Legal Guardian (type first and last name)
*
The last four (4) digits of your SSN#
*
Today's Date
*
-
Month
-
Day
Year
Date
Camper Covenant
The participating student must read and sign the following statement:
The Camper Covenant
I understand that this is retreat is a unique opportunity to have fun, build relationships, and encounter God. I will respect the rule, the adult leaders, the property, and the safety of everyone in attendance. I commit to fully participating and making this the best event for me as I am able to. I understand that failure to respect the rules, persons, or property could result in me being required to leave the event early at the expense of my family. But I know that wouldn’t be a problem!
I have thoughtfully read and understand the Camper Covenant
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Yes
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Camper Covenant.
*
Yes
Signature of Camper (first and last name)
*
Today's Date
*
-
Month
-
Day
Year
Date
Congratulations!
You've completed the Online Registration Form for your student. Your next step is: 1. Send your deposit monies to the church you are attending with. 2. Remind your NYI Director or Pastor to send ONE church from your church to lock-in your registration cost
Guardian Name
*
Guardian Email Address
*
What's next?
You will receive a confirmation email from nmayo@dublinmedicalcenter.com with reminders and packing instructions. This email address will be used to send a follow-up reminder the week of the Fall Retreat.
Submit
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