CSA Retreat
Emergency Information

MEDICAL MATTERS: I hereby warrant that to the best of my knowledge, I am in good health, and I assume all responsibility for my current health state.

Emergency Medical Treatment: In the event of an emergency, I hereby give permission for myself to be transported to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the even of an emergency, please contact:

(Including relationship to participant)
Summit Retreat Information
Everyone is responsible for getting themselves to the retreat, but we will coordinate available carpools
Camp Dixie is in Elberta, approximately 1.5 hrs away from the University
PLEASE SUBMIT FORM AND PAYMENT ($40) TO THE CSA BY THURSDAY, FEBRUARY 8, 2019

*Scholarships are available if needed*
Contact Emma with questions (561-348-4976)