Howdy Retreat — First Baptist Church, Corbin Kentucky

“Howdy” Youth Fall Kick Off Retreat

Saturday, Sept. 14th: 3-7:30 pm

(PLEASE NOTE ADJUSTED TIME, SCHEDULE, & LOCATION)

We’re excited to kick off our fall semester and welcome in our new youth! Cost is FREE, but registration is required (see below). Filling out this form will also renew parental consent for your student to participate in youth/children activities at FBC Corbin for Sept. 2024-Aug. 2025.

(See below for a schedule as well as a link for info about the rafting trip!)

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2-3 pm: Van Pickup
3 pm: Meet @ FBC
3:10 pm: Drive to Campbell’s Ceramics
3:15-5 pm: Pottery Painting @ Campbell’s Ceramics!
5-6:30 pm: Pizza & Games @ Pinball Museum
6:30-7:30 pm: Choose Your Own Adventure Ice Cream Party @ FBC Youth Suite
- “Colossal Ice Cream Creations!” Party
- Welcome Incoming 6th Graders and Group Reflection
7:30: Pickup from parents @ FBC
7:40-8:40 pm: Van returns kids home (if needed)

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Student's Name

First Name

Last Name

Birthday

YYYY

Grade

T-Shirt Size

Parent/Guardian 1

Parent/Guardian- First & Last Name

Parent/Guardian 2

Parent/Guardian 1- Phone

(###)

###

####

Parent/Guardian 2- Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical Stuff

Does your Student have hospitalization insurance?

Yes

Medications/Allergies

Please list any medications your child is taking or any food/drug allergies:

We like to capture memories

Do you give FBC of Corbin permission for your student’s picture/video to be taken and displayed?

Yes

Student Needs

Any conditions/restrictions you would like us to be aware of for your child (i.e. asthma/rescue inhalers, limitations on physical play, accessibility & sensory needs, etc.)?

General/Vehicle Permission & In Case of Emergency

By clicking SUBMIT you are agreeing to the following: General/Vehicle Permission- I, the parent/guardian(s) listed above, give permission for my student to attend the above mentioned FBC of Corbin activity and ride in any vehicle designated by the adult in whose care the minor has been entrusted while participating in these activities. In Case of Emergency- I, the parent/guardian(s) listed above, authorize the adult, in whose care the minor has been entrusted, to consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis, treatment, and/or hospital care, to be rendered under the general or special supervision and on the advice of any medical professional licensed under the Medical Practice Act whether such diagnosis or treatment is rendered at the office of said professional or at said hospital. I agree to be liable/pay all costs associated with any necessary treatment.