Retreat Student Information Form
Please fill out this form and click submit.
STUDENT INFORMATION
Parent Name
Email
Student Name
Student Grade
Birthdate
How did you hear about Lake Ann camp?
Are you a returning attendee?
Church Attending With: Immanuel Bible Church
STUDENT ACCOMODATION AND DIETARY INFORMATION
Does the student need any special accommodations made to participate in retreat activities?
Does the student have any dietary allergies?
I certify the above student has my, _______________, permission to attend this retreat and participate in all activities. I also realize that my student’s picture or testimony may be used in the promotion of Lake Ann Camp, and may receive emails from Lake Ann Camp and Retreat Center. (Please type parent name)
Relationship to student?
Parent/Guardian Signature
Signature Date
Submit
Description
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