Students Winter Retreat Friday, January 19, 2018 6:00 PM 18:00 Sunday, January 21, 2018 12:00 PM 12:00 Google Calendar ICS WHAT Students Winter Retreat | AnchorWHEN: Friday January 19-21WHERE: Canyon CampRegistration Due January 7thRegister Name * Name First Name Last Name Attending As * If Leader, use your information instead of Parent's Student Leader Parent Name * Parent Name First Name Last Name Parent Name 2 Parent Name 2 First Name Last Name Parent Email Address * Parent Phone Number * Parent Phone Number (###) ### #### Age * Grade Health Insurance Provider * Health Insurance ID Number * Preexisting Medical Conditions * Current Medications Emergency Contact Emergency Contact First Name Last Name Emergency Contact Number Emergency Contact Number (###) ### #### Tshirt Size Not Specified Small Medium Large XL 2XL 3XL PERMISSION, LIABILITY & MEDICAL RELEASE * I (we), the undersigned parent(s) or guardian(s) of the above mentioned student agree to hold New Covenant UMC, the Oklahoma United Methodist Conference, and the event leadership team free from liability for injuries, damages , or losses unless caused by willful or intentional conduct on the part of the leadership team or leadership. As legal guardian(s) I (we) give permission to the church or trip staff to seek medical attention if needed for this participant. I (we) as legal guardian(s)/parent(s) also give permission for the above named child's personal property to be searched, if just cause is determined by the event staff. If such search is deemed necessary, the participant's property is to be searched in the presence of two staff persons, designated by the Event Leader/Site Official. I (we) give my permission for my child to be photographed or videotaped, which may be used by New Covenant United Methodist Church for event promotions. I agree Thank you!