Student Registration Form

July 8th - 14th, 2019 // Daytona Beach, FL
**We may return on Saturday the 13th - TBA**
Cost: $210.00

Student Information
Name *
Date of Birth *
Date of Birth
Phone *
Please Note: 2XL (add $2.00) & 3XL (add $2.00)
Is your child a good swimmer? *
My child is bringing their own surfboard/skimboard: *
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Permissions & Acknowledgements
I Understand My $85.00 Deposit Is Due For This Trip Along With This Form By Wednesday, May 2nd, 2019. *
I Understand My Balance Is To Be Paid In Full By Wednesday, June 30th , 2019. *
The total cost of the trip is $115.00. Your deposit of $40.00 is due December 5, 2018. You will then owe a remaining balance of $75.00 by February 6, 2019.
I Give Permission For My Child To Attend Adrenaline 2019. *
My child has a medical release form on file for 2019. This is to acknowledge that my child has my consent to attend Adrenaline 2019 on July 8th - 14th, 2019 at the El Caribe Resort in Daytona Beach, FL. I understand my child will be accompanied by an adult volunteer from Church on the Hill. I understand the transportation to and from Adrenaline 2019 will be by car, van, or bus provided through Church on the Hill. Approved adult leaders from Church on the Hill and FDM will be driving the vehicles.
There Are Always Dangers Involved With Surfing and Swimming In The Ocean. *
My child understands the importance of listening to the chaperones and lifeguards.

If you would like to pay online, please click the button below. You may submit your deposit only or pay in full. Please designate your payment to "Youth Ministry."