2025 High School Fall Retreat Registration 2025 High School Fall Retreat Parent/Guardian First Name * Parent/Guardian Last Name * Parent/Guardian Phone * Parent/Guardian Email * Emergency Contact (other than previously listed parent/guardian) * Emergency Contact (other than previously listed parent/guardian) First Name First Name Last Name Last Name Emergency Contact Phone * Students Student Name * Student Name First First Last Last Student Cell Phone Number Dietary Restrictions Gluten-free Dairy-free Fee Student Fee: $35.00 plus1 Add Student minus1 Remove Student Liability Release * I understand I must download, fill out, and turn in the Liability Release Form As the parents and guardians, we do hereby give permissions for these children to participate in the High School Choir Fall Retreat sponsored by The Choir Company. This event includes an overnight stay at Collinsville Free Will Baptist Church. I/We also forever discharge and agree to hold harmless The Choir Company, directors, the sponsors, and volunteers of The Choir Company from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child/participant that occur while the said child is participating in choir activities during the Fall Trip occurring on November 7-8, 2025. I/We further authorize the Choir Director, or any sponsor in whose care the minor has been entrusted to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it become necessary for my/our child to return home due to medical reasons, discipline problems, or other reasons, I/We shall assume all transportation costs. The undersigned does also hereby release The Choir Company and any and all traveling companions or agents for the children’s trip from any liability for any loss or injury while en route, during, and returning from the event. Download the Liability Release here. Total Payment Payment is processed through Stripe. None of your card information is stored on our servers. Submit If you are human, leave this field blank.