Confirmation Retreat

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Streaming Video

Confirmation Retreat

November 11-13
Crystal Beach

* Parent/Guardian's Full Name

* Parent/Guardian's Email

* Parent/Guardian's Cell

* Student's Name

* Student's Dietary Restriction(s)

Student's Allergy Details (if applicable)

Other Health Info (activity limitation, notes, etc.) - if applicable

* Emergency Contact 1 Full Name & Cell

e.g. "Sara Smith 713-529-5771"

* Emergency Contact 2 Full Name & Cell

e.g. "Dan Smith 713-529-5772"

* Emergency Authorization

Emergency AuthorizationI hereby give permission to the medical personnel selected by the Retreat Director to order x-rays, routine tests and treatment for my child, and in the event I cannot be reached in an emergency, I hereby give my permission to the Retreat Director to hospitalize, secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child as named above.

* Upload Vaccination Card

Sun, April 28 2024 20 Nisan 5784

Confirmation Retreat

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