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Kingdom Bound
Who: The Resistance Youth Group
Cost: $300 + Spending Money to cover 4 meals (See Information Packet)
When: Tuesday, July 21st through Monday, July 27th We will be meeting at Integrity Christian
Fellowship on Tuesday, July 21st at 7:00PM. (We will be sleeping at the church and leaving 3:00AM on
Wednesday, July 22nd) and We will be returning to Integrity Christian Fellowship on Monday, July 27th at
approximately 6:30PM
Where: Darien Lake Theme and Water Resort in Darien Center, NY
Please sign and return bottom portion
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In accord with the provisions of the Combined Permission; Release, Waiver of Liability, and Indemnity
Agreement; and Emergency Medical/Contact Information for Children and Youth Activities, previously
executed by the parent(s) or custodial adult(s) of:
Child’s Name:____________________________
I, as parent or custodial adult, give permission for my child/youth to participate in the following activity:
Kingdom Bound 2015 from Tuesday, July 21st to Monday, July 27th.
Changes to emergency contact or medical information (please remind us of allergies/prescriptions here):
____________________________________________________________________________________
____________________________________________________________________________________
_________________________________
Parent/Custodial Adult Signature
Office Use Only:
Paid: Yes / NO
Cash / Check #_______
________________
Date
Forms? Y/N
_____________________________
Cell Phone