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This is an area to describe the details of the event. Or you could have any information in here really, it just doesn't matter all that much. But the real test of an area like this is how much text it can actually hold. I mean, surely there must be limits. Right? Well if there are we sould probably display a Link Style.

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This is an area to describe the details of the event. Or you could have any information in here really, it just doesn't matter all that much. But the real test of an area like this is how much text it can actually hold. I mean, surely there must be limits. Right? Well if there are we sould probably display a Link Style.

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ST. DAVID'S EPISCOPAL CHURCH
763 South Valley Forge Rd.
Wayne, PA 19087

CALL US: 610.688.7947

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WORSHIP SCHEDULE:

8:00am | Church

9:15am | Chapel
11:15am | Church
5:00pm | Church

 

 

Houston Trip Registration

Please fill out the form below to register for the Houston Mission Trip. If you have any questions, contact Sarah Champlin at schamplin@stdavidschurch.org.

If you would rather fill out a physical form to print out and send to St. David's, click here.

**PLEASE REMEMBER** Upon submitting this online application, please remember to additionally send the following to St. David's Church:

  • Copy of School or I.D. of Participant
  • Copy of Insurance Card of Participant
  • $200 non-refundable deposit made out to St.David's Episcopal Church; Memo: Houston Mission Trip Patricipant's Name

 

Participant Information:
Name of Participant: *
First Name
Middle
Last Name
Date of Birth (mm/dd/yyyy):*
Gender:*
List any medical issues, allergies, etc (if none, just write N/A): *
Grade Entering in Fall:*
Participant Phone:*
Participant Email:*
Family Information:
Parent Name: *
First Name
Middle
Last Name
Phone:*
Full Address:
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Physician Name:*
Physician Phone Number:
Insurance Company:*
Insurance Phone Number:*
Policy #:*
Emergency Contact Name: *
First Name
Middle
Last Name
Emergency Contact Phone:*
Emergency Contact Relationship:*
Permission for Publicity: During the 2018 Houston Summer Work Trip, St. David’s Episcopal Church takes photographs or makes an audio or videotape recording of children and/or adults involved in church/youth trip. I consent to the use of any such audio or visual record of the child named above or me, if I am participating, to be used, distributed or displayed as agents of the church see fit.
Permission for Publicity:*
Release of Liability: By signing this waiver form, I grant permission for the child named above or I, if I am a participant, to participate in and engage in the 2018 Houston Summer Work Trip of St. David’s Episcopal Church. My child or I are physically and mentally able to participate in these activities, unless I have already discussed it with one of the leaders. I acknowledge that there are certain risks involved in said activities, and have discussed them with my child if necessary. I release St. David's Episcopal Church, its affiliates, volunteers, and employees of all responsibilities for any injuries, to body or property, which may occur to my child during the course of these activities. In the event of an emergency in which I or the alternate contact cannot be reached, I authorize the adult leaders to make medical decisions for my child, and to administer first aid if deemed necessary. I further agree to indemnify and hold harmless St. David’s Episcopal Church and its affiliates, volunteers, and employees of any and all claims arising from my child’s or my participation in activities or as a result of injury or illness of my child or I during such activities. I represent that I am the participant, or parent/guardian of______________________, who is under 18 years of age. I have read the Permission/Waiver Form and am fully aware with the contents thereof. I give permission for the child named above or I to fully participate in the activities of St. David’s Episcopal Church.
Signature of Parent/Guardian:*