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Registration for Youth Retreat 2022

NY Youth Metro Region Retreat 

November 18-20, 2022

Tuscarora Inn & Conference Center


Departing at 12PM on November 18

*Please note that students will have to miss a half/full day of school to attend this trip.

Cost: $200 (includes admission and transportation from 11/18-11/20 ) due by October 28, 2022

Exclusively for youth in 7th - 12th grade

 Registration Details 


 Health & Permission Slip 

 Emergency Contact Information 

If you have medical insurance, your carrier will be billed for medical charges in the event of an illness or injury while your child is under the supervision of Bethlehem Assembly of God and the New York Ministry Network.
Do you have health insurance?
If your child should require medical attention for injuries received or illnesses contracted prior to activity, please send us the necessary information to give him/her proper medical care during his/her time with the youth ministry.

 Health History Information 

Are there any pre-existing medical conditions?
Is your child on any medication?
Does your child have any allergies?
Does your child have any reaction to certain medications?
Please mark what is appropriate to your child.
If emergency treatment is required, may those in charge of the group use their own judgement in sending the child to the doctor or hospital before the parents are reached?
NOTE: Every attempt possible will be made to get in touch with the parents! I hereby grant permission for my son/daughter, (type your child's name below), to attend the 2022 NY Metro Region Youth Retreat Trip. I also grant permission for my son/daughter to receive necessary medical attention. I understand that if my child damages any church or public property, due to horseplay or violent outbursts, I will be personally responsible for all costs related. If my child refuses to participate and/or follow instructions from the BYC leaders I understand that they will be sent home at my expense.
I have read the terms & waiver form. I have filled out this form to the best of my knowledge. By filling out my name, I agree to the statements listed throughout this Permission slip.

Thanks for registering!

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