Elementary School Retreat – The Coptic Orthodox Church

Dates

Friday 5/30 – Sunday 6/1

Location

SPRUCE LAKE

5389 Rt 447, Canadensis, PA 18325

SPRUCE LAKE

Fees

$200

Regulations

Important items to bring with you:

Pajamas,Socks & Underwear – enough for each day
Clothes to cover the retreat
Pants & T-Shirts for the liturgy
Tonya (for deacons)
Sneakers |Flip Flops
Toothbrush, Toothpaste
Deodorant, Perfume
Comb, Brush, Hair Accessories
Bath Towel
Bible, Notebook, Pen
efillable Water Bottle
Any type of medication needed during the stay.
Bug spray
Shampoo

Who is Rigestring *

Name *

First

Last

Number Of Children *

School Grade first Child *

School Grade second child *

Second Child Name *

First

Last

School Grade Third Child *

Third Child Name *

First

Last

Emergency contact *

First

Last

Child Rigestration Phone *

Phone *

Does the Child have any known Allergies? *

List of Allergies *

Email *

First elementary Child Fee *

Price: $ 200.00

Second elementary child Fee *

Price: $ 200.00

Third elementary child Fee *

Price: $ 200.00

Single Item *

Price: $ 200.00

Release and Waiver of Liability

I agree to the following terms and conditions:

1. Acknowledgment. I desire for my child to attend Pope Kyrillos & Arcdeacon Habib Girgis Church Summer Fellowship (“Summer Fellowship”) provided by Pope Kyrillos & Arcdeacon Habib Girgis Church (the “Church”), and for my child to engage in activities (the “Activities) related to the Summer Fellowship both on and off the Church’s premises. I understand that such activities may include, but are not limited to, sports, bowling, roller-skating, ice-skating, jumping on trampolines, rock-climbing, swimming, and hiking.

2. Consent to Obtain Medical Treatment. I hereby give consent and authority to the Church to obtain medical treatment on my child’s behalf if my child is injured or requires medical attention during his or her participation in the Activities. I understand and agree that the Church shall not be responsible for any costs related to such medical treatment, and I hereby release and hold harmless the Church, and each its agents, clergy members, employees, volunteers, and affiliates, from any claim relating to such treatment or medical services.

3. Release. I hereby fully and forever release and discharge the Church, along with the Coptic Orthodox Archdiocese of North America, and each of their respective clergy, members, employees, volunteers, agents, and representatives, from any and all liability, claims, and demands of any kind or nature, either in law or equity, that may arise as a result of my child’s participation in the Activities. I agree not to make or bring any such claim or demand against the Church, and fully and forever release and discharge the Church from liability under such claims or demands. I understand that this release discharges the Church from any liability or claim that I may have against the Church with respect to any damage or loss that may result from the Activities, whether caused by the negligence of the Church or otherwise.

4. Full Understanding. I hereby agree that this Release represents the full understanding between the Church and me and supersedes all other prior agreements, understandings, representations, and warranties, both written and oral, between us, with respect to the subject matter of this release and waiver of liability.

Child Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date / Time *

Date

Time

Parent Name *

First

Last

I am the parent or legal guardian of the individual named above. I have the legal right to consent to this Release and do so by signing below. * *

Phone *

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