Registration for the Middle School summer retreat begins here...
August 3-6, 2017
Fireside Retreat Center
Corbett, OR

Harvest Community Church
What is your student's name?

What is your student's gender?

What grade is your student going into?

What is your name (parent/guardian)?

What is your phone number (parent/guardian)?

Please include area code.
What is your address?

Who is the best emergency contact (besides you) for your student?

What is this person's relationship to your student?

What is the best phone number for this emergency contact?

Please include area code.
Please list your student's medical information and medications:

(You will also be required to fill out Harvest's medical release form which you can find online and will receive via email after submitting this form.)
Please list any special dietary need requirements for your student:

Do you give permission for your student to have over the counter medication (i.e. Advil, Tylenol, etc.)?

Does your student have all current immunizations?

Do you give consent for pictures taken of your student on the retreat to be posted on our website or Facebook page?

Please download a Harvest medical release form AND a Ski Bowl release form here to complete and return to the church office as soon as possible: http://www.harvestcc.info/get-involved/youth

Payments can be made to "Harvest Community Church" with your student's name and "Middle School summer retreat" in the memo line.

We will be going to Skibowl for a half day on Friday. The following activities are included: Alpine Slide, Sky Chair/Bike Lift, Mountain Bike Park, Kiddy Canoe Ride, Super Play Zone, Pony Rides, Kiddy Karts, Summer Tube Hill, Bouldering Wall, Aqua Rollers, Miniature Golf, Disc Golf, Slack Lines, Badminton, Horseshoes, Jacob’s Ladder, Volleyball and Bungee Trampolines, 32’ Tall Rockwall, Batting Cages. We will not be allowing zip lining, bungee jumping, or other activities that include an extra cost.

Thank you for registering your student for the Youth Retreat of 2017! 
Do you have any comments or questions?

Attention: Before continuing, please make note of the following important information.
We will be at Fireside Retreat Center: 37936 SE Gordon Creek Rd, Corbett, OR 97019
Greg Goostree: (360) 977-3484
Fireside Retreat Center: (503) 695-2418
Please write these numbers down in case you need them over the weekend!

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