Chapel in the Hills - Camp Regen 2025 Permission Slip

Permission Slip for
Chapel In The Hills
Youth Retreat @ Camp Regen
July 20th - 24th, 2025

Glorieta, New Mexico
11 NM-50,
Glorieta, NM 87535
Camp Regen Website

The total cost of this event is $569. There is a $150 Deposit that is due before April 1st and the remaining amount is due before July 1st. After submitting this form you will be redirected to the registration page to submit the deposit. It is also available on the Chapel Calendar for this event.

*You must register/make payment in order to attend this event.

The Church is assisting in the financial cost of this event. If you would like to contribute more and help cover the additional cost please utilize Chapel In The Hills online giving and select the fund "Youth Retreat". Thank you!

Parent/Guardian Emergency Contact

First Name of Parent/Guardian

Last Name of Parent/Guardian

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Student Information

First Name of Student

Last Name of Student

Age

Birthdate

Gender

Travel Arrangements

Our current plan is to carpool from Chapel in the Hills at 29579 State Hwy 72 Golden CO 80403 on July 20th, 2025 and drive to Glorieta, NM together (Approx. 6 hour drive). and return in the same manner on July 24th.

Select one

Yes, I give permission for my child to ride with an adult driver.

My child will meet the group at Camp Regen in Glorieta, NM.

Other *

*Please provide more info if needed.

Please read and sign acknowledging and giving permission for your student to attend

I, the undersigned parent/guardian, authorize permission for the above student to attend Chapel In The Hills Youth Retreat on July 20th-24th, 2025 at Camp Regen located at 11 NM-50, Glorieta, NM 87535. As parent/guardian, I do hereby release, forever discharge and agree to hold harmless Chapel In The Hills, other church staff and adult volunteers from any and all accidental and unintended liability, personal injury, sickness or death. I assume all responsibility as a result of student’s participation in church-sponsored activities.

I give my permission for my child to be photographed. I understand these photographs will be used at the church's discretion.

Should it be necessary for my child to return home due to medical reasons, disciplinary action or otherwise, I hereby assume all costs involved. This is a binding covenant and agreement.

Parent/Guardian Signature