Evangelical Bible Church

Dallas, Oregon

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November 22November 25
The number of spaces you wish to reserve.
The email to associate with this registration.
Home Address
If you prefer, send a copy of your insurance card with your child.
I the parent / guardian, give permission for this student, if necessary, to go to the nearest hospital/clinic and receive appropriate treatment as deemed necessary by the attending medical personnel. If medical attention is needed, every reasonable attempt will be made to notify me as soon as possible. I understand that Evangelical Bible Church is not responsible for the cost of medical care provided to my child. I assume responsibility for the transportation of my son/daughter in the case of any non-related emergency situation that results in an early dismissal. My son/daughter has permission to attend this retreat and participate in all activities.
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