CBA Middle School Retreat Oct 2023 (Grades 5-7) Permission Slip

Name of Student (Please complete a separate form for each student)(Required)

First Last

Name of Parent/Guardian 1(Required)

First Last

Parent/Guardian 1 Phone Number(Required)

Name of Parent/Guardian 2

First Last

Parent/Guardian 2 Phone Number

By checking this box, I affirm acknowledgement of the following trip details.(Required)

I agree

Dear parents of students in Grades 5-7, Your child's class is going on a 3-day retreat! This is an excellent chance to further your child's growth outside of the classroom. PURPOSE: A special time of team-building discipleship as the 5th-7th grade teachers and Dr. Nathan Johnson spend concentrated time focused on building courageous leadership in our students. Activities and talks will be purposefully planned to develop servant leadership and teamwork. Students will be staying at Ridgecrest Conference Center in Black Mountain, NC. We have reserved both a boys and a girls bunk room. We will be leaving from school at 8:45 am on Wednesday, October the 18th. Please arrive no later than 8:30 that morning. We will return Friday, October 20th, at 5:00 pm at the HABC campus. The school is covering the cost of the trip but asks each family to pay $100 to help expenses. Students will be provided with further information regarding what to bring with them as the date approaches.

Parent/Guardian Permission (please select one):(Required)

My child WILL attend the 3-day retreat. I understand the benefits and risks associated with this trip. I understand the money is non-refundable as reservations will be made.

My child will NOT attend the 3-day retreat. I recognize that I will keep my child at home on the date of the trip. I also understand my son/daughter will miss the valuable learning experience. He/she may also be given an assignment to work on at home so as to not miss out on learning.

Special circumstances, allergies, or concerns

By checking this box, I affirm that I have provided CBA with all parent/guardian contact information and any special conditions for my child (allergies, medical conditions, etc.). I also agree that I will keep all parent/guardian and all student information (including medical information) up-to-date in the Student database (FACTS).(Required)

I agree

By checking this box, I affirm that I have carefully read and signed the Field Trip Liability form for the 23 - 24 school year and agree to its terms knowingly and voluntarily. This consent and release submitted to CBA for this school year has been read and is understood by myself.(Required)

I agree

By checking this box, I affirm that I have carefully read and understood the information regarding this specific retreat.(Required)

I agree

Emergency Contact Name OTHER than Parent/Guardian Contact (School will attempt to call parents first)(Required)

Relationship to student(Required)

Emergency Contact Phone Number OTHER than Parent/Guardian (School will attempt to call parents first)(Required)

I have submitted any payment due via Venmo to charlestonbilingualacademy.(Required)

I agree

I am the parent/legal guardian of the child named above.(Required)

I agree

Parent/Guardian Signature

Date