Winter Youth Retreat at Akita Registration Form
I/We do hereby give permission for my/our above named child to be transported by Broad Street Presbyterian Church to attend and participate in the Presbytery of Scioto Valley Winter Youth Retreat at Camp Akita from February 22-24, 2019.
I, the undersigned, being the parent or legal guardian of the child named above, permit my child to participate in all camp activities and certify that the above information is correct. I give permission for my child/me to be photographed during camp activities and for the Presbytery to use such photographs in publicity. I give permission for PSV to administer prescribed medications and provide routine health care. I understand the presbytery will not be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. In the case of accident/injury, I give PSV permission to seek medical attention for my child/ me and arrange necessary transportation and I understand that if my child needs emergency care that PSV will attempt to contact me immediately.
Church: Broad Street Presbyterian Church
Today's Date: September 20, 2019