Space is limited!!! Sign up today!!! ONLINE


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Summer Retreat @ Forest Home — July 28-30, 2017 SBCC Jr. High and High School Ministries Liability and Emergency Medical Release Form Student’s Name: _______________________________________ Address:______________________________________________ Health Insurance Co: ____________________________________ Policy #: ______________________________________________ Allergic to any medicine/food(s): ___________________________

Forest Home Camp & Conference Center—Creekside www.foresthome.org Sign up today for an awesome weekend of faith, fun and fellowship!

Departure: 2pm Friday, July 28, 2017 Return: 3pm Sunday, July 30, 2017 Drop off & pick up at SBCC 2549 W. 190th St., Torrance 90504 (between Van Ness & Crenshaw)

Any medical condition: ___________________________________ I hereby for my heirs, executors, administrators or anyone else who might bring claims on my behalf, covenant not to sue, and waive and discharge South Bay Community Church, all charities benefiting from this event, event employees, all volunteers, event board and corporate members, and any and all sponsors, including their agents, employees, assigns or anyone acting on their behalf from any and all claims of liability for death, personal injury, or personal damage of any kind whatsoever, foreseen or unforeseen, known or unknown. I, furthermore, give my expressed permission to any and all event sponsored adult personnel to authorize emergency medical care to my child/children if deemed necessary by a licensed medical professional. Parent/Guardian’s Name:_________________________________

Registration: Complete & submit the following 1. SBCC Liability/Emergency form 2. ONLINE Forest Home Medical/Liability form 3. Payment in full $165/student

and Phone : _________________________________________

ONLINE

Price includes 2 nights, 5 meals, retreat activities and t-shirt. Last day to register is July 16th.

Space is limited!!! Sign up today!!! Bus Transportation provided by SBCC No refunds after July 16th.

For more information: Sally (310) 210-2593 [email protected] James (310) 755-1809 [email protected]

Signature: ______________________________Date: _________ Emergency Contact Name: _______________________________ and Phone: __________________________________________ Adult T-Shirt Size: S_____ M_____ L_____ XL_____2XL_____ Payment Options (check one):  I am making my payment on-line via credit card/electronic check on the www.southbaycommunitychurch.com website  I am paying the retreat fee via cash/check. Amount submitted today: $___________ Cash or Check #_________ THE FOREST HOME CAMP FORM IS NOW ONLINE. Please complete the online form for each student attending. (see next page for instructions)