Registrant

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Student
Student
Student
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Student
Student
Registration cost includes transportation, lodging, most meals, and programming content and materials. Full price is required at the time of registration. Refunds are not available. *Financial assistance is available through the Students Trips Scholarship Fund. Applications can be submitted through the Scholarship Request Form, and they are due by January 12th at 11:59 PM. *Any student not able to attend for the whole trip needs to be approved by the Students Team through an email to Students@MountainCC.org before January 19.
I acknowledge that participation in the Senior Retreat with Mountain Students involves risk to the participant (and to the participant’s parents, guardians, and family members), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, and personal injury. In consideration for the opportunity to participate in the Senior Retreat, the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Senior Retreat or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the church staff or volunteers. By checking this box, I agree to the above terms and conditions.
Please indicate whether you agree: I give permission for medical attention to be given to my son/daughter in case of injury, including major surgery. I understand that I will be contacted as soon as possible in case of an incident.
To ensure the safety of all students, Mountain requires all over-the-counter and prescription medication be turned in to the trip medication leader. Students cannot self-carry pain relievers, cold medications, etc. MCC will have ibuprofen and acetaminophen for headaches or other pain that with your consent, the trip leader may provide to your student according to the directions on the bottle. MCC will also have Benadryl for allergic reactions that with your consent, the trip leader may provide to your student according to the directions on the bottle. Permission to self-carry some medication may be granted by the trip medication leader. A leader will call parents if there is any concern about the health of the student. Indicate below which over-the-counter medication and pain relievers are acceptable to give to your student. If any additional medication will be administered on the trip, a Medication Administration Form is required. A link to that form will be available in the confirmation email.
Please indicate whether you agree: I am the parent or legal guardian of the child herein, a minor. I understand that there may be occasions when Mountain Christian Church (“MCC”) will want to use photographs or audio or video recordings from Church activities or events in which my child participates. I grant to MCC the right to include photographic, video, audio and other visual or audio portrayals of my child taken during or in connection with Church activities or events in any medium of any nature whatsoever (including the right to edit, combine with other materials or create any type of derivative thereof) for the purpose of advertising, publicity, promotions, or otherwise, without compensation to me or my child. Such grant shall include the unrestricted right to copy, revise, distribute, and display photographs, images, films, tapes, drawings or recordings in any type of media (including, but not limited to, the Internet). I consent to the use by MCC of my child’s testimonial, comments and/or narrative writing in any manner, free of charge, in any form or media. I understand the wording of any testimonial, comments and/or narrative writing may be edited or altered, provided that the sense and meaning are not materially changed. I agree that all rights, title and interest therein shall be MCC’s sole property, free from any claims by me or my child or any person deriving any rights or interest from me or my child. I release MCC and its agents and assigns from any and all claims which may arise out of or are in any way connected with such use.
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