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Student Registration Form

February 15th - 17th, 2019 // Covington, GA
SPEAKERS: Andy + Danielle Stinespring
Cost: $115.00

Student Information
Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Please Note: 2XL (add $2.00) & 3XL (add $2.00)
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Permissions & Acknowledgements
I Understand My $40.00 Deposit Is Due For This Trip Along With This Form By Wednesday, December 5, 2018. *
I Understand My Balance Is To Be Paid In Full By Wednesday, February 6, 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 Winter Retreat "Soundtrack" 2019. *
My child has a medical release form on file for 2018. This is to acknowledge that my child has my consent to attend the “Soundtrack” Winter Retreat on February 15-17, 2019 at FFA Camp in Covington, GA (South East Atlanta). I understand my child will be accompanied by an adult volunteer from Church on the Hill. I understand the transportation to and from Winter Retreat 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.

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."