2021 All Stars | Winter Retreat Student Registration

Student Full Name (학생 이름)

Student Cell Phone

Student Email

Grade (학년)

Parent 1/Guardian Name (부모 1/ 보호자 이름)

Parent 1 Phone (부모 1 전화번호)

Parent Email (부모 이메일)

This address will receive a confirmation email

Parent 2 Name 부모 2 이름 ("n/a" if not applicable)

Parent 2 Phone 부모 2 전화번호 ("n/a" if not applicable)

Emergency Contact (긴급 연락처)

Emergency Contact Name (이름)

Relation to Student 학생과의 관계 (e.g., grandmother, aunt)

Emergency Contact Phone (긴급 연락처 전화번호)

COVID-19 Guidelines

To ensure the safety of our students, we will be taking the follow precautions:

1) Everyone, including students and leaders, will wear masks at all times.
2) We are asking our students and leaders to be vaccinated before attending the retreat. Please provide below either (1) a picture of the vaccination card or (2) the date of the second dose of the vaccine. If the student is NOT vaccinated, please bring a negative COVID test result (either PCR or rapid test) taken within 72 hours prior to attending the retreat.

To learn more about what Sandy Cove Ministries are doing to keep us safe, please refer to their Health and Safety Policy below:
https://www.sandycove.org/about-us/health-and-safety

Although KCPC All Stars will be taking all the precautions listed above, KCPC All Stars is not liable for a potential COVID-19 infection from the retreat.

I have read and agree to the above statment regarding COVID-19 policy at the retreat.

I agree

Photo of the Vaccination Card

Upload (8MB)

Date of the Second Dose of Vaccination (If NOT vaccinated, please write "n/a")

Registration Fee (등록비)

If you will be paying by check, please fill out our check-only form:
https://kcpc.breezechms.com/form/covenantchk

Instructions for the checks will be in the form.

Payment $120

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Welcome to AS Winter Retreat 2021 Student Registration Form!

ONE per student. If there are siblings, please fill out another form.

The retreat will be Sunday, December 26 - Tuesday, December 28 at Sandy Cove.
We're so excited you're here and can't wait to worship together this retreat!
If you have any questions, feel free to shoot an email to allstars@kcpc.org.

*If you are a PK or MK, email allstars@kcpc.org for a separate form!*

**If you will be paying by check, please fill out our check-only form:
https://kcpc.breezechms.com/form/covenantchk
Instructions for the checks will be in the form.

2021 All Stars | Winter Retreat Student Registration

Description

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