Hume Lake Winter Camp

Name of Student attending

Attenders Phone

Attenders Date of Birth and Grade

Address

Parent/Guardian's Name

Parent/Guardian's Phone

Parent/Guardian Email

This address will receive a confirmation email

Secondary Emergency Contact and Phone Number

Health Insurance Carrier and Policy Number

Any Allergies/Disabilities/Meds?

I understand all reasonable safety precautions will be taken at all times by Faith Community Church and its agents during the event and activities. I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Faith Community Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form. I give permission for my son/daughter to attend.

Payment:

Cost is $425 (only $350 if you sign up by Oct. 1 with $135 deposit)

Donate for Scholarships or to help pay for youth leaders

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Friday January 30-Sunday February 2

FCC Youth is going to WINTER CAMP!!!!
Join us for an exciting 3-day winter adventure at Hume Lake. Get away from the ordinary rhythms of life and have some fun with friends, make space for your faith and see how this weekend deepens our community.

CHECK-IN
Friday, January 30 at 9am- yes we will be skipping school!
Check in at FCC

RETURN
Sunday, February 1st, 6ish
Arrive back at FCC

COST: $425
EARLY BIRD: $350 ($320 for camp, $30 for gas)
---$135 Deposit due by October 1st to reserve your spot or cost goes up to $425

SCHOLARSHIPS AVAILABLE!
Contact youth@santacruzfaith.org

Hume Lake Winter Camp

Description

Please Fix the Following