Mount Traber Bible Camp

Teen Retreat Registration

Name_______________________________

Age_____

Grade______

Email________________________________
Phone #______________________________
Health Card #_________________________
Expiry Date___________________________
Allergies_______________________________
Medical/Health/Behavioural Concerns________________________________
Dietary Restrictions_______________________________________________
Parent/Guardian Name(s)______________________________________________________________
Phone #________________________________ Email_______________________________________
Emergency Contact_____________________________________ Phone #_____________________
Retreater will be picked up by___________________________________________________
Conditions/Policies (Please indicate permission given by a check-mark and sign below)
___In case of emergency I hereby give permission to MTBC to obtain medical treatment or hospitalize retreater if
necessary
___I hereby give permission for my retreater to participate in horseback riding, supervised by MTBC staff. Every effort
will be made to ensure the safety of all riders, however, with riding, there is always a risk of injury.
___MTBC has permission to use any likeness or image of my child for promotional purposes (Ex: brochure, website)

Parent/Guardian Signature________________________________________________________
Retreat Registration/Check-In Begins Friday at 6 pm. Pick Up is Sunday at 2 pm.