Wednesday, February 22, 2012

Montreat Registration – On-line registration

Youth Basic Info:
Youth's Name*
FirstLast
Age*
Age on July 17, 2011
Grade completed (as of June, 2011)*
Please enter a value between 8 and 12.
Cell Phone
Home Phone*
What medical conditions/allergies should Rob know about?*
Answer can be "none".
Guardian(s) Info:
Name (Guardian 1)*
FirstLast
Guardian 1 Best Phone*
Guardian 1 Email
Name (Guardian 2)
FirstLast
Guardian 2 Best Phone
Guardian 2 Email
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal Code
Use address where youth lives if multiple addresses are involved
Emergency contact in case guardians cannot be reached:
Name*
FirstLast
Phone*
Relationship to youth*
Youth In-depth Info:
Is this your first trip to Montreat?*
- Yes
- No
Why do you want to go on this trip?*
Youth Medical Info:
Medical Insurance Company
Type of plan
Plan number(s)
Name of Family Doctor*
FirstLast
Phone Number of Family Doctor*
Current Medications
Allergies
Parent Medical Approval:
I give my permission for my son/daughter (enter youth's name below)
Youth's Name
FirstLast
to travel with the Wallingford Presbyterian Church to Montreat, NC. In the event of an emergency, I also give my permission for any medical treatment that may be necessary for him/her.
Electronic Signature
Name of Parent or Guardian*
FirstLast
Email of parent or guardian approving the trip*
email signature must match email name of submitter to be valid
Please return this form and a non-refundable deposit of $150 by April 1st. (Make checks payable to Wallingford Presbyterian Church). The earlier you get your deposit and registration form in, the higher in the order for picking rooms you’ll be!
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Worship Times

Fall to Spring (9/11/11 - 5/20/12):
Worship at 9:30 and 11 AM
Sunday School at 9:30 AM
Nursery/childcare provided

Summer (5/27/12 - 9/2/12):
Worship and Sunday School at 10 AM
Nursery/childcare provided

Ash Wednesday Service
February 22 at 7:30 PM
Valentine Cupcake Decorating
Upcoming Events
Links