Snow Retreat 2019
Snow Retreat 2019
Date: January 18th-20th Place: Pleasant Valley Ranch: 4023 Oh-603, Perrysville, OH 44864 Registration is at Pleasant Valley Ranch at 6-7pm on Friday, January 18th
Pick up will be at Pleasant Valley Ranch at 11:50 AM on Sunday, January 20th.
Name  * 
Students Age:
Student's Date of Birth
Students Grade:  * 
Students Phone Number:  * 
Name of School Student Attends:  * 
Parent/Guardian Name:  * 
Parent/Guardian Phone Number:  * 
Your Email Address  * 
Emergency Contact Name:  * 
Emergency Contact Phone Number:  * 
Student's Health Insurance Carrier:  * 
Health Insurance Policy Number:  * 
Name of Church Student Attends:
Special Medical Instructions or Medication Instructions: (If no instructions please put N/A)  * 
If invited by a student please enter their name:
If your students is a part of a Home Group at Pursuit student ministries please enter the leader's name:
Tee-shirt size:  * 
Does student want to enter Friday Dodge ball Tourney?  * 
Would your student like to participate in the Hantis Tournament?
If the student will be leaving any time during the retreat please list the pick up time, return time, and driver.
By typing my name as legal guardian, I give permission to the registered student to attend Snow Retreat. In case of medical emergency, appropriate treatment will be administered.  * 
Total $
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