Eagle Eye Ministries

2017 Toledo Teen Summer Institute

from 50.00
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2017 Toledo Teen Summer Institute

from 50.00

When: June 24 - July 2

Who: Ages 16-18+

Location: Our Lady of Consolation Retreat House (Carey, OH)

Cost: $335 ($345 if purchased online). Full refund not available after May 27

For any questions, please contact bethy20078@aol.com

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When: June 24 - July 2

Who: Ages 16-18+

Location: Our Lady of Consolation Retreat House (Carey, OH)

Cost: $335 ($345 if purchased online). Full refund not available after May 27

For any questions, please contact bethy20078@aol.com

Name *
Name
Birthdate *
Birthdate
if applicable
Parent/Guardian's Name *
Parent/Guardian's Name
Address *
Address
Home Phone *
Home Phone
Participant's Phone *
Participant's Phone
Parent's Cell Phone *
Parent's Cell Phone
Parent's Work Phone
Parent's Work Phone
Medical Information
Physician's Name *
Physician's Name
Physician's Phone *
Physician's Phone
This information will help us be attentive to your needs
Date of most recent Tetanus shot *
Date of most recent Tetanus shot
Medical Insurance Info
Emergency Contacts
Mother's Name
Mother's Name
Phone Number
Phone Number
Phone Number
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Authorization for Emergency Medical Treatment
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Liability Release and Permission to Transport Summer 2017 (June 24-July 2)
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Publicity/Photo Release
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Code of Behavior
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