Youth Retreat / Retiro de Jóvenes 2026

Youth Retreat / Retiro de Jóvenes 2026

6th-12th Grade Only / Solo de 6to a 12vo Grado
Parents / Padres*

First Name / NombreLast Name / Apellido
Phone Number / Teléfono*
Favor ingrese un número de teléfono válido.Format: (000) 000-0000.
Email / Correo Electrónico *
Release Form
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physician Name
Physician Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Medical History
Medications
Allergies
I, ____________________________________, the undersigned do hereby agree to release and forever waive any claim which may arise against employees or volunteers of House of Praise International Church. This waiver of rights shall be effective immediately and shall continue to be in force until my son/daughter completes this Activity: Encounter Retreat May 15-17, 2026. The location will be Stony Glenn Camp 5300 W Loveland Rd, Madison, OH 44057. This release specifically includes all claims and demands of whatever nature, actions and causes of actions, damages, costs, loss of services, expenses and compensation on account of or in any way growing out of personal injuries, illnesses, and/or property damage having already resulted or to result at any time in the future, whether or not contemplated at the present time or whether or not they arise following the execution of this release. The release expresses a full and complete release of any liability, past or future, which may be claimed against House of Praise International Church, its trustees, officers, employees and any volunteers. The Legal guardian agrees to accept all financial responsibility for the cost of any medical treatment or expenses the child may incur. In witness whereof, releasor executes this release on the day and year written below.
Parent Signature*
Student Signature*
Registration Payment / Pago de registración*
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Youth Retreat Registration / Registro para el Retiro de Jóvenes
Mandatory payment for each participant registered / Pago obligatorio por cada participante inscrito

$90.00 Quantity

Total

$0.00
Notes / Notas
Payment Methods

Fastlane Pago

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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Youth Retreat / Retiro de Jóvenes 2026

Release Form