High School Retreat @ Camp Willow Run

November 20-22, 2009

Student Name:

Address w/ zip:

Parent Email:

School:

Grade:

Parent Phone #:

Emergency Contact Name:

Emergency Contact Phone #:

Does student have a general permission on file?:

(If no, one needs to be completed)

T-shirt size:

Note: Everyone who registers his/her student online is still required to turn in a Camp Willow Run medical form and a signed trip permission form located on the back of the High School Retreat brochure.

YesNo

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