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 7-9, 2020.
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: March 29, 2020