Generation Unleashed Pay In Full

February 7th - 9th 

Cost: $150 - Complete this form to pay $150 in full today

Open to all High School Students! The cost is $150.



Student Name
Parent/Guardian Name
Relationship to Student
Address
Parent/Guardian Phone Number
Parent/Guardian Email
Acknowledgement:
I, the above named parent/guardian, give my permission for all students listed above to participate in the overall activities of the Revive GU Trip. I give permission for my student(s) to receive medical attention in the case of an emergency. I/We agree not to hold Bethel Church, its leaders, employees, agents or volunteer staff liable for damages, losses, diseases, or injuries incurred during the events by the student(s) listed on this form.
Parent/Guardian Signature


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Payment Details

Your total due for 'Generation Unleashed Full Payment' is $150.00

Cardholder Name:
Card Number:
Card Expires:
CSC:

Email Address for Receipt (Required):

Billing Address:

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