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Student *
Student Cell
Student Cell
Guardian *
Best Contact Number *
Best Contact Number
Name of Contact If Different Than Guardian
Name of Contact If Different Than Guardian
Please list any allergies or medications needed for your student
Parent Consent *
The undersigned parent or guardian does grant permission for the named child(ren) to participate in the Holy Trinity Church Youth Summer/Fall Retreat from August 23rd - 25th @ Camp Manitoqua. The undersigned recognizes that this trip and its activities will be under adult supervision as outlined in HTC’s Child Protection Policy. The undersigned also grants permission for such approved supervisors, as well as any licensed physician, to take any emergency steps that appear to be necessary in care of the child(ren) in attendance. The undersigned also recognizes that all trips and activities are designed for the benefit of the named child(ren) participating in the given event. It is understood that HTC, its employees, and approved adult leaders will exercise and execute caution, good judgment, and care. It is also understood that though such care be exercised, HTC cannot and will not be held responsible by the undersigned in case of accident, injury, and loss or damage of property in connection with these trips/activities and that the undersigned will save HTC, its employees, and approved adult leaders harmless from all such claims. The undersigned further agrees to admonish the child participating in the program to exercise care, to be well behaved, and in all things obedient to and under the direction of those adults in charge.


To secure your student’s spot at Summer/Fall Retreat, please click below to pay the full cost of $145

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