Student Life Mission Trip 2020 - Registration Form

Deadline to register is January 12th or when available spaces have been filled (whichever comes first).

MISSION TRIP PARTICIPANT INFO
Student's Name*
First Name
Last Name
Student's email, if different from parent's
Student's Age*
Student's Grade in School for 2019/2020 School Year*
Student's T-Shirt Size (adult sizes)*
Small
Medium
Large
Extra Large
2XL
PARENT INFO
Name of Parent or Guardian completing this form*
First Name
Last Name
Parent or Guardian Preferred Phone*
Preferred email address to receive important info about the Retreat.*
ADULT VOLUNTEERS - The mission trip cannot happen without our awesome adult volunteers. The number of students we can take is limited by the number and gender of adult volunteers and drivers. Please consider joining us and sharing this experience with your child and the rest of our wonderful youth. We promise you will be blessed!
I can provide snacks or drinks for the mission trip.
I would like to attend the mission trip as an adult volunteer.
Name of adult volunteer
First Name
Last Name
Make & model of my vehicle (if able to drive):
Number of passengers I can carry (including driver):
Adult's T-Shirt Size (adult sizes)*
Small
Medium
Large
Extra Large
2XL
EMERGENCY CONTACT INFO
Emergency Contact for July 13th-17th (if different from or in addition to parent named above)
First Name
Last Name
Preferred Phone for Emergency Contact on July 13th-17th.
SPECIAL DIETARY NEEDS FOR PARTICIPANT?
FOOD ALLERGIES, VEGETARIAN, VEGAN?
PARENT AGREEMENT
By submitting this form I agree that my son/daughter has permission to participate with LUMC Youth in the Student Life Mission Camp at Liberty University in Lynchburg on July 13th-17th, 2020. I will turn in a check for the non-refundable $70 deposit (payable to LUMC Youth) to reserve his/her spot and understand that his/her space is not reserved until that deposit is received in the church office. I have read the trip info sheet and understand that the remaining balance of $300 is due no later than June 7th. If I have not already done so, I will complete a 2019-2020 "Parental Consent, Medical Emergency & Liability Release Form" for my child. I will also have my child complete and turn in the Mission Trip application form and Code of Conduct form, all of which can be found on the LUMC Youth website (www.lumcvb.org).