Timber Lodge Ranch 2020

Student's Information

Name

Gender

Female Male

Grade they will be in for the coming school year.

Grade

9th 10th 11th 12th 13th

Phone

Allergies

SHIRTS WILL BE MADE BY GILDAN SO PLEASE SIZE APPROPRIATELY.

Shirt Size

S M L XL XXL XXXL

Parents Information

Parent or Guardian Name

Parent or Guardian Phone

Parental Consent

I, the parent or legal guardian of the child mentioned above, am informed of Sager Creek Community Church’s offering to host the child mentioned above at Timber Lodge Ranch, on the days of 6/24-28/2020. I understand that payment of $150 dollars has to be made to Sager Creek Community Church on or before June 24, 2020 I hereby authorize Sager Creek Community Church, its leaders, employees and volunteers who are 18 years of age or older, and supervise the activities during 2020 to consent to emergency medical care, dental care, or both, for my child. As the parent or legal guardian of my child, I acknowledge that according to the Arkansas Governor’s guidelines this environment is not considered “safe” and I understand that the student mentioned above is voluntarily participating at their own risk. I hereby consent for my child to attend and will not hold Sager Creek Community Church, its leaders, employees, and volunteers responsible for any bodily injury or sickness incurred during the event.

This address will receive a confirmation email

To pay with cash or check select cash/check from the drop down menu. If you are paying with cash/check you can drop off your payment at the church office or give it to Nathan Nall on Sunday mornings. Please make checks payable to Sager Creek Community Church.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Timber Lodge Ranch 2020

Description

Please Fix the Following