Fall Retreat Permission & Signup Form
Please fill out the form carefully to give permission for your child's participation, provide insurance and emergency contact details, and pay the $75 deposit.
Student's Full Name
*
First Name
Last Name
Student's Tshirt Size
Please Select
YXS
YS
YM
YL
AS
AM
AL
AXL
A2x
A3x
Student's Grade
Please Select
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Details Other Than Parent/Guardian Listed Above (Name, Relationship, Phone)
*
Insurance Information (Provider, Policy Number)
*
Upload Health Insurance Card Front and Back
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How Do You Want To Pay
Please Select
Cash/Check In Giving Station
ACH or Credit Credit Card
My Child Needs to Be Scholarshipped
Payment Options
Sort By
Name: A to Z
Name: Z to A
Price: Low to High
Price: High to Low
Clear Sort
prev
next
( X )
Fall Retreat Deposit Only
$94.50
$
94.50
Fall Retreat Full Balance
$189.00
$
189.00
Authorization
By signing this form, I am giving permission for my child to go on the Ft Caswell, November 6-8, 2026.
Submit Permission Form
Should be Empty: