Location Information

Location Name
Baltimore White Marsh SDA Church
Address
7427 Rossville Road, Rosedale, MD, 21237 US
Directions
Google, Bing, MapQuest

REGISTRATION

REGISTRATION FEE ($295.00)
Trip fees cover lodging, meals, ground transportation, staff, projects and 6 Flags Ticket. Airfare ticket or transportation to White Marsh Church is not included. You can purchase it online or with an agency or using your miles.

MY CITY MY PASSION

I have read and agree to the terms above.

Parent's or Legal Guardian's Information

Father's Name

Mother's Name

Parent's or legal guardian's Email

Parent's or Legal Guardian's Secondary email

Parent's or Legal Guardian's Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Parent's or Legal Guardian's Secondary Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Minor's Information

Minor's Name

Minor's DOB

Address

T-Shirt Size

Church's Information

Church's Name

Address

Pastor's Name

Pastor's Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Emergency Contact Information

Name

Primary Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Secondary Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Relationship to the minor

Medical Form

In case of an emergency, parents will be contacted immediately. We would only need this information in case a minor needs immediate care and parents cannot be reached.

Doctor's Name

Doctor's Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

First person to call in case of an emergency

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

List all known allergies

PARENT/GUARDIAN AUTHORIZATION FOR HEALTH CARE IN CASE OF AN EMERGENCY

Terms

This health history is correct and accurately reflects the health status of the minor to whom it pertains. The person described has permission to participate in all activities except as noted by me and/or an examining physician. I give permission, in case we cannot be reached, to the physician selected by the church to order x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the physician to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for this child. I understand the information on this form will be shared on a “need to know” basis with church staff. I give permission to photocopy this form. In addition, the church has permission to obtain a copy of my child’s health record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

I have read and agree to the terms above.

If your child has experienced COVID-19 symptoms 5 days prior to July 9, please make sure to have your child tested negative before bringing them to church.

Convenience Fee

$3.00

Running Total

$298.00

Coupon Code

Total

$298.00

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

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Location Information

Parent's or Legal Guardian's Information

Minor's Information

Church's Information

Emergency Contact Information

Medical Form

PARENT/GUARDIAN AUTHORIZATION FOR HEALTH CARE IN CASE OF AN EMERGENCY

Billing Information