2026 5•8 D-Group Retreat

Participant Contact Information

Student Name

Parent Name

Parent Email

Parent Phone Number

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Address

Registration Information

Gender

Male
Female

Date of Birth

Grade

5th Grade
6th Grade
7th Grade
8th Grade

School District

Name 3 Friends You'd Like To Be In A D-Group With

Name of D Group Leader(s) You Would Prefer

Terms & Agreements

As the parent or legal guardian of the above named minor, I give my permission for him or her to participate in the 5•8 D-Group Retreat with Christ's Church of Oronogo. I understand the inherent risks that are involved in this event and hereby release CCO, its staff, employees and volunteers from responsibility and liability for any injury or illness sustained during this event.

Further, I do authorize the minister, adult leader, or sponsor of the event, or any CCO staff member, in the event I cannot be reached by phone, to give consent to a physician and or hospital for emergency medical or surgical treatment. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

I have read and agree to the terms above.

I authorize Christ’s Church of Oronogo to use photographs and/or video footage of the participant for future promotional material.

Photography Release

By typing your full name, you are electronically signing this form and acknowledging that your online consent is equivalent to a binding legal signature.

Parent/Guardian E-Signature

Today's Date

Behavorial Terms and Agreement

I understand that if attendee should exhibit behavior that is inappropriate, at the discretion of the Christ's Church of Oronogo staff, they will be sent home from the 5•8 D-Group Retreat. Transportation will be the responsibility of the attendee and/or parent or guardian and the registration fee will not be refunded.

I have read and agree to the terms above.

By typing your full name, you are electronically signing this form and acknowledging that your online consent is equivalent to a binding legal signature.

Parent/Guardian E-Signature

Today's Date

Travel/Attendance Terms

I understand, it is my responsibility to have my child at check-in at Camp Cyokamo, Alba, MO by 2:00pm on Saturday, November 14, 2026.

The expectation is that each person attends the 5•8 D-Group Retreat in its entirety.

We will not be providing lunch on Sunday, November 15th. Pickup time will be from 11:45am - 12:15pm. We would love for you to take this opportunity to visit with your child's D-Group leader and ask any questions you may have concerning your child's D-Group.

I have read and agree to the terms above.

By typing your full name, you are electronically signing this form and acknowledging that your online consent is equivalent to a binding legal signature.

Parent/Guardian E-Signature

Today's Date

Medical Information

Medical Insurance Company

Primary Name Insured on Policy

Policy Number

Physician's Name & Contact Number

Allergies

Special Considerations & Information

Medications Currently Taking

Over-The-Counter Medication Approval

Please be aware that there will NOT be a nurse at this event. Over-the-counter medications will be available through Christ's Church staff if needed. These include: ibuprofen, acetaminophen, naproxin, cold medicine, allergy medicine, Dramamine, Immodium, Pepto, Tums, antibiotic cream, hydrocortizone cream, sunscreen and aloe vera.

PLEASE SELECT ONE OF THE FOLLOWING OPTIONS:

I agree to allow my child to receive the above listed over-the-counter medications if necessary.

Please DO NOT administer the following medications to my child:

List any medications that you do not wish for your child to receive. State "All" if you do not wish for your child to be administered any of the above medications.

Parent/Guardian E-Signature

Today's Date

Emergency Contact Information

Primary Emergency Contact

Primary Emergency Phone Number

Secondary Emergency Contact

Secondary Emergency Phone Number

Payment Information

**Thank you for registering your child to attend the 5•8 D-Group Retreat. Please note that after the 5•8 D-Group Retreat registration closes on November 8th, the student registration fee of $40 will be non refundable.

Registration Options

Student Registration ($40.00)

Total

$0.00

Coupon Code

Scholarship Funding

If you would like to increase opportunities for our students and leaders to attend trips and events through Christ's Church of Oronogo, please enter a donation amount below to contribute to our student ministry scholarship fund.

Your help is greatly appreciated! Thank you very much for partnering with us!

Donation Amount

Total

$0.00