Providence Bonne Terre - Permission Forms

Youth Retreat - Bates Creek 2024

I give permission for my student to attend the Youth Retreat with Providence Baptist Church and to travel with the other participants and leaders to the locations of the events for the weekend.

I understand that the retreat will take place from Friday, October 4, 2024 until Sunday, October 6, 2024.

The majority of the retreat will be held at Bates Creek Baptist Camp in Potosi, MO, but there may be events that require participants to travel to other locations.

Student First Name

Student Last Name

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Emergency Contact First Name

Emergency Contact Last Name

Relation to Student

Emergency Contact Phone Number

Emergency Contact #2

Please list any allergies/medical conditions that we should be aware of:

Parent/Guardian Signature

Youth Retreat - Bates Creek 2024

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