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Family Member Attending #1 (if applicable)



Family Member Attending #2 (if applicable)



Family Member Attending #3 (if applicable)



Family Member Attending #4 (if applicable)



Family Member Attending #5 (if applicable)



Authorization from Parent or Guardian

I hereby authorize my child(ren) to participate in the First Presbtyerian Church, Houston retreat to Mo Ranch from Thursday, July 13 through Sunday, July 16, 2017. Realizing the nature of emergencies, and that I may not be able to be reached, although every effort will be made to do so, I give my permission that medical measures may be instituted without delay as the judgment of the physician selected by the staff of First Presbyterian Church, Houston deems necessary, be it an injection, an anesthesia, or surgery.

Housing Preference

Miscellaneous Information

Please type the name of the person/family who invited you to Mo Ranch

Please type their email address here

Please include any special needs and/or preferences (accessibility, housing, severe allergies, etc.)