PLEASE READ IMPORTANT INFO BELOW:
Even though the trip dates are April 21-23, 2023, FULL registration and TOTAL registration payment of all FLATE-RATE fees MUST be submitted on or before THURSDAY, MARCH 30, 2023. Flate-rate registration fees become NON-REFUNDABLE after March 30, 2023. Both hotels require an accurate rooming list and The Ark Encounter group account must be paid in full by Friday, March 31, 2023 or our reservation will be canceled.
Thank you very much.
Pastor Corey
(703) 909-4423 (cell)
(703) 922-6700 (ofc)
pastorcorey@crbc.org
PARTICIPANT'S INFORMATION
You will need to take a NEW (TODAY) photo/selfie of your entire frontal face (without a mask) - a normal head shot. For reference, think of what your school picture looks like. You will attach this file to this registration form. Photo should not be a group shot - it MUST be of your face alone. There is a reason for this requirement. Thank you. Pastor Corey
If you (PARTICIPANT) have your OWN email account (not a parent's email) that you check on a regular basis, please provide that email address in the next field.
If you (PARTICIPANT) will be bringing your OWN cell phone on this trip (if you have one, please bring it) please provide your cell number in the next field. DO NOT enter a parent's cell phone number.
PARTICIPANT'S WELL-BEING SECTION
NOTE: Any/all required prescription medication(s) MUST be contained in its original RX bottle with 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.
On Friday night, April 21, we will be eating dinner at Hall's on the River in Winchester KY. For our group rate of $20 per person (included in the flat-rate fees) it is required that we know what you will be ordering for dinner. Please look over the menu below and then identify your choice in the next field. Note: the $20 per person fee includes meal, drink, tax, and gratuity. Unfortunately, we cannot change your menu selection after this registration form is submitted, so please choose carefully.
Halls On the River Menu Choices:
Hall's Famous Hot Brown
This is an iconic KY classic served in a piping-hot black skillet. It's a hot open-faced sandwich originally created at the Brown Hotel in Louisville, Kentucky, by Fred K. Schmidt in 1926. The legendary, open-face sandwich, which is made from Texas toast, thick-sliced turkey, cheesy Mornay sauce, crisp bacon and tomatoes, all baked until bubbling hot.
Fried Catfish Dinner
This is Hall's signature fish dish. The catfish is served with crispy potatoe fries and yummy hushpuppies.
Chicken Alfredo
Served with grilled chicken and garlic bread. This is also available without the chicken, if you prefer.
Pulled Pork Plate
Served with Texas Toast, Coleslaw, and Greens - with your choice of BBQ sauce.
Hall's Cheeseburger
Served on a Brioche Bun with Lettuce, Tomatoes, Onions, and Pickles (on the side) with your choice of American, Swiss, or Jack Cheese. Comes with crispy potato fries.
While at Hall's On the River, you will also be able to enjoy (compliments of Pastor Corey) appetizers of KY's famous Beer Cheese with Crackers and Celery, Crispy-Fried Banana Peppers, Frog Legs, and Lamb Fries (we'll identify what Lamb Fries are at the restaurant).
PARENT/GUARDIAN INFORMATION
This section is not necessary for Youth Leaders to complete. Therefore, the following Parent/Guardian fields are set up as "NOT REQUIRED" fields (which means that this form may be submitted without data in these fields. Therefore, parents/guardians of participants MUST ensure that the Parent/Guardian fields ARE complete before submitting this form.
PARENT PERMISSION AND MEDICAL RELEASE INFO
PARENT/PARTICIPANT COMMUNICATION
FORM COMPLETION VERIFICATION & STATEMENT
PAYMENT FOR FLATE-RATE FEES