Random Name

Teen Girls Retreat 2026
PERMISSION FORM

 
  A T T E N D E E   I N F O R M A T I O N  
 
Name *

 
Birth Date *

 
Phone *

 
Address

 
City, State Zip

 

I give permission for my 12-18-year-old daughter (named above) to attend the Teen Girls Retreat being held Jan. 23-24, 2026 at Camp CUMCITO (13563 Missouri 7, Warsaw, MO 65355).
If you have any questions on subject matter, call Tammy Paulsen at 660-438-9140 and ask questions prior to signing this document.

 
Parent/Guardian Signature *

 
Date

 
Printed Name

 
 


  P A R E N T / G A U R D I A N   I N F O R M A T I O N  
 
Name *

 
Relationship to Participant *

 
Phone *

 
Secondary Phone *

 
Email

 
Address

 
City, State Zip

 

  E M E R G E N C Y   C O N T A C T  
 
Name

 
Relationship to Participant

 
Phone

 

Girls should bring bedding such as pillow, sleeping bag or blankets, pajamas, change of clothes, and their Bible if they have one.

 
  * Required