Student Ministry Fall Retreat 2022

Friday October 21- Sunday October 23 | Please fill out this form and click submit.
Student Information

Student #1

 
Please select one option.
Please select one option.
Please select one option.
 
 
Student #2

Please fill out additional student sections if applicable, otherwise feel free to skip.
 
Please select one option.
Please select one option.
Please select one option.
Student #3

Please fill out additional student sections if applicable, otherwise feel free to skip.
 
Please select one option.
Please select one option.
Please select one option.
Parent/Guardian Information

 
 
 
 
 
Emergency Contact Information

Please list an emergency contact separate from the Parent/Guardian information listed above. 
 
 
Terms and Conditions


I give my student permission to attend The Fall Retreat with the Green Level Baptist Church Student Ministry.

I/We understand that all reasonable safety precautions will be taken at all times by Green Level Baptist Church and its agents during the events and activities.


I/We authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency.


I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk.

I/We give our student permission to go to Naylor Family Farm & Giant Corn Maze and all events on/off Green Level Baptist Church Campus throughout the duration of this event.

I/We understand that there will be times throughout the Fall Retreat that cell phone usage will be discouraged and will contact Pastor Zack or one of the student leaders in the case of an emergency.


I/We agree not to hold Green Level Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, illness, or injuries incurred by the subject of this form.

I have read, understand, and agree to the above terms and conditions. Please initial and date as your virtual signature and verification.
 
 
Event Cost

Please select the number of Students you are registering for the correct payment amount. If you would like to sponsor a student or add an additional donation, choose to pay for one more Student than you are registering.

 

If you prefer to pay with cash or check, choose that option from the payment drop-down menu and let Pastor Zack know the way you desire to pay. Thank you!

The student ministry at Green Level Baptist Church never wants money to be a hindrance to someone coming to an event. If the cost would be a hindrance for your family please reach out directly to Pastor Zack. We have scholarships available. 
 
 
 
 
 
 

Description

Friday October 21- Sunday October 23
Please fill out this form and click submit.