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Islands of Adventure - Youth Group

Islands of Adventure Trip
March 29,2025
Cost: $180 per person 
(For grades 5 - 12


 
Youth #1 Information
Youth #2 Information
Youth #3 Information

Parent Information
If no parent 2 please put N/A in the box.
If no parent 2 please put N/A in the box.
If no parent 2 please put N/A in the box.
If address differs from parent 1 please put information in the box. If address is same please put N/A.

Emergency Contacts
Parents are always contacted first, however, in case of illness, accident or injury please list additional people below who can be contacted.
Please Include:
Full name
Relationship to your child(ren)
Phone #
Include the following information:
Name of Insured
Name of Insurance Company
Policy #
Include the following information:
Doctor Name & Phone Number
Parent Consent & Release
I give my child(ren) permission to participate in the TBE Youth Department's Islands of Adventure Trip, March 29, 2025. In the event of an emergency, medical, surgical or otherwise, and i cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility and specifically authorize the representative of TBE to select a physician and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which they feel are in the best interest on my child. Further, I accept full responsibility for payment of any such services rendered.
Both parents need to sign (even if parents are separated or divorced). If there is no parent 2 please put N/A. 

Participant Agreement
I agree to abide by all rules and regulations of the TBE Youth Trip. I understand that violation of the rules may result in curtailment of activities, and or early departure home. 

Payment Agreement
$180 per child 

Once you submit this form you will receive an email with a payment link. Please submit payment so we can confirm your child(ren)s registration for the Youth Group Islands of Adventure Trip. Thank you!

Mon, March 10 2025 10 Adar 5785