The online application contains Camper info, parent/ guardian info, payment plan, health form, and agreement. Please complete all sections to the best of your abilities.

We have had many successful retreats, and we look forward to having your son/daughter attend Youth Retreat 2010. In an effort to better assist you, we are offering several payment plans that will help ensure your child’s attendance on this retreat.

Pay in full by February 28, 2010 – discounted fee ($150.00)

1st installment - Registration fee - $50 ~~ 2nd installment - $60, due by March 21 ~~ 3rd installment – $55, due by April 25

1st installment – Registration fee - $50 ~~ Ten- $12.50 installments – due by April 25th

We are obligated to pay the retreat facility for the number of persons we register. As a result, we are requiring all parents/guardians to enter into a covenant agreement with us to satisfy your financial commitment. We, the Youth Ministry, are partners with you, the parents and guardians, to help prepare our children for a better future.

Read the Agreement and sign below

I (your name) have read and understand the financial requirements for the Youth Retreat that is to be held on May 28 -30, 2010. I (Your name) do understand that I am responsible for complete payments once my child is registered, regardless whether they attend the retreat or not. I understand that if my payment is not fulfilled by April 25, 2010, my reservation is subject to cancellation.

*NOTE: you must supply your own tape for pre-existing conditions

The health history is correct, so far as I know, and the person herein described has permission to engage in all prescribed camp activities, except as described on this application. In the event I cannot be reached in an emergency, I hereby give permission to the youth coordinator(s) to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above:

I/ We _____ acknowledge that my child, _____ is voluntarily participating in the Youth Retreat 2010 activity sponsored by the Thessalonia Baptist Church on May 28, 2010 though May 30, 2010. I/ We understand that all reasonable safety precautions will be taken by the leaders of this activity, and that the possibility of an unforeseen hazard does exist. I/We agree that either the Thessalonia Baptist Church, nor its trustees, representatives, employees, or agents may be held liable in any way for an occurrence in connection with the activity which may result in injury, harm, or other damages to the named youth, or members of our family and guests, invited or not. As Part of the consideration for being allowed to participate in your sponsored activities, I/ We hereby assume all risk in connection with participation in the activity.

I/ We further release the Thessalonia Baptist Church, its trustees, agents, or reps. for any damages that may occur while participating in the activity. I/ We further agree to save and hold harmless the Thessalonia Baptist Church, its trustees, employees, agents, or reps. from any claim by the undersigned member of the organization, their estates, heirs, or assigns arising out of or participation in any form or fashion in the activity. I/We also authorize Thessalonia Baptist Church, its employees or agents to render or obtain such emergency medical care or treatment as may be necessary should any injury, harm, or accident occur while participating in the activity. I/We have listed all known medial information including allergies, activity restrictions, prescribed medications, and emergency notification on this document. I/We agree that it is my/ our responsibility to complete a new written TBC PARENTAL CONSENT HOLD HARMLESS AGREEMENT & MEDICAL RELEASE FORM whenever changes to any of the contained information should occur.

I/ We further state the I/We are authorizing to sign this agreement; that I/we understand the terms herein are contractual and not mere recital; and that I/we have fully informed ourselves of the content of this affirmation and release by reading it before I/we signed it.