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Event Registration

Event: Inside Out [beach trip]

Date: July 14th – 20th , 2012

Event Details: We will be going to St. George Island for our 7 th consecutive year to understand God's provision for lives to be made “Inside Out ” before Him.

Total Cost includes all meals but two.

Deposit Cost: $50 Total Cost: TBD

Deposit Due Date: May 15th, 2012

Final Payment Due Date: June 22 nd 2012

Please make Checks payable to: NGBC

(Please submit form & money to: Pastor Keith)

 

 

Student Information

Last Name:
First Name:
Grade:
Age:
M F
Phone:
Email:
Address:
City/State/Zip:

Parent / Guardian Information

Name(s):
Email:
Home Phone:
Other Phone:

 

Medical Information (please make a copy of Ins. Card)

Physician Phone #:
Insurance Card #:
Card Expiration Date:

 

Medical Conditions or Allergies: (Please make special note of food allergies)

 

Medication(s) Currently Being Taken: (Please note medication names and times taken)

Permission Form

Student

I promise to abide by all rules and plans set forth by the leaders of New Georgia Baptist Church during the course of this event.

Signature:

Date:

 

Parent

I / we are the legal guardians of the student named above and hereby give my / our permission for the named student to participate in the above named event with the leaders of New Georgia Baptist Church . I understand that in the event of an emergency that the leaders of New Georgia Baptist Church will do everything in their power to contact me personally, but that in the event that they are unable to do so, I / we give my / our permission for the leaders to seek necessary medical attention for the student named above.

Signature:

Date: