D/C Retreat Permission Form


I GIVE MY STUDENT PERMISSION TO BE TRANSPORTED TO AND PARTICIPATE IN THE D/C RETREAT AT LAKE BEAUTY BIBLE CAMP WITH THE BETHLEHEM COVENANT CHURCH YOUTH GROUP ON FRIDAY AND SATURDAY JAN. 13-14. AND IF I CAN NOT BE CONTACTED IN CASE OF EMERGENCY, TO SECURE AND ADMINISTER MEDICAL TREATMENT, INCLUDING HOSPITALIZATION, FOR THE CHILD NAMED ABOVE. I AGREE TO HOLD BETHLEHEM COVENANT CHURCH HARMLESS FOR ANY AND ALL CLAIMS FOR INJURIES, CAUSES FOR ACTION, OR LIABILITY RELATED TO USE OF FACILITIES AND/OR TRANSPORTATION.

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My family and I can contribute $ of the $50 registration fee. The amount requested for need-based scholarship is $ ($50.00 less your contribution). I understand that receiving a scholarship for this Lake Beauty event may reduce (by the awarded amount) the scholarship awards available to this student for other Lake Beauty Events, including Summer Camp.


Date Signed:

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Bethlehem Covenant Church http://www.bethcov.org
Signature Certificate
Document name: D/C Retreat Permission Form
Unique Document ID: 918c399bca650b13d501bdc7a6206c2bf7141e13
Timestamp Audit
2016-12-29 09:01:10 CDTD/C Retreat Permission Form Uploaded by tim Shekleton - fathershek@gmail.com IP 98.159.184.212