FRI, January 3 - SUN, January 5, 2025
PLEASE READ THROUGH ALL THE FIELDS AND DIALOGUE SECTIONS CAREFULLY. THANK YOU.
You will receive a Registration Confirmation Email after submitting this form that will provide all of the information contained in this registration form for your records. If you have any questions, please contact Vivian Morales at (703) 922-6700 or by email at vivian.morales@crbc.org.
TRIP DURATION:
We will depart on Friday, 1/3 at 2:00 P.M. from Calvary Road and will return Sunday, 1/5 between 6-7 P.M.
EVENT REGISTRATION REQUIREMENTS:
1. Complete this INITIAL registration form.
2. Complete a Medical Release Form for each event participant (minor) in your household (if NOT ALREADY submitted for a prior event). SEE BELOW...
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Destination:
Camp Kanesatake
4976 Camp Kanesatake Ln
Spruce Creek PA 16683
814-632-6024
Depart: Friday, January 3, 2025 @ 2:00 P.M.
Return: Sunday, January 5, 2025 btwn 6-7 P.M.
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Trip Costs: $160 per student (plus extra money for a fast-food dinner on Friday night on the way to CampK)
NOTE: In addition to the fast-food meal on Friday night, we will be stopping (both ways) at the Sheetz in Breezewood PA for gas and restroom breaks. If your student wants to purchase drinks/snacks at these to/from stops, please plan for additional money.
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The link to the Medical Release Form will be sent to you in a Registration Confirmation Email once you submit this INITIAL form. If you do not receive an immediate Registration Confirmation Email after submitting this INITIAL form, please contact Vivian Morales at (703) 922-6700 or vivian.morales@crbc.org
If your student will have a cell phone during this event, it is imperative that you provide the number in the next field. Only IF your student will not have a cell phone during this event should you leave the next field BLANK. Thanks!
NOTIFICATION OF STUDENT'S MEDICATION REQUIREMENT
NOTE: Any/all required prescription medication(s) MUST be contained in its original RX bottle w/the student's name printed on the bottle as printed from the RX provider. Any RX meds that do not have the student's name on the bottle, as printed from the RX provider will not be permitted. Also, please make sure dosage instructions are printed on the RX bottle, again, as printed from the RX provider.
PARENT/GUARDIAN (1) INFORMATION
PARENT/GUARDIAN (2) INFORMATION
MEDICAL RELEASE FORM AGREEMENT
NOTE: After you submit this form, you will receive a link where you can complete your student's Medical Release Form in your Registration Confirmation Email.
If you have already completed a Medical Release Form since September 1, 2024, you DO NOT have to complete the form again...UNLESS important information, that would negatively affect your student's well-being, has changed.
FYI...All students who attended our last event (Liberty University's Homecoming) already have an active Medical Release Form on file.
