Harvest Youth, June 14-20, 2025

Space is limited!

Student Information:

Name

Grade:

Phone (optional):

Birthdate:

T-shirt size:

Student allergies, medications, or needs:

Parent Information

Parent/caregiver 1 name:

Parent/caregiver 1 relationship to student:

Parent/caregiver 1 cell phone:

Parent/caregiver 1 email:

This address will receive a confirmation email

Parent/caregiver 2 first and last name:

Parent/caregiver 2 relationship to student:

Parent/caregiver 2 cell phone:

Parent/caregiver 2 email:

Emergency contact name:

Emergency contact cell #:

Waiver

I understand that outdoor activities such as mountain biking, hiking, rock climbing, swimming, watersports, and canoeing are activities that involve risks, both known and unknown, for participants. My child’s participation in this event is voluntary and I assume full responsibility for any accidents, injuries, illness, or death of my child to myself.

Yes

Parental/Caregiver Consent I have read the waiver and consent to my child participating on this trip:

Yes

I authorize Harvest Fellowship to use my likeness in photograph, video, or other digital media:

Yes

Initials:

Description

10-12th graders (9th grade with permission): This summer, join Harvest Youth on an amazing 7-day discipleship training adventure to the black hills of south Dakota!

Date: June 14-22

Cost: TBD, approx. $350

More details forthcoming

To claim your spot, please fill out all the information in the form. If you have questions, just ask Jon!

Jon.harvestmn@gmail.com

320-333-8439

Harvest Youth, June 14-20, 2025

Description

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