Nightwatch at The Cathedral Church of St. John the Divine

1047 Amsterdam Avenue

New York, NY 10025

212 316-7490

My child ____________________________ has my permission to participate in the Community Church of Glen Rock Confirmation Class trip to St. John the Divine in New York, NY on

October 7 – 8 2011.

I have signed the waiver form if my child is a minor.  Enclosed is my check for $48 to cover the program fee, payable to the Community Church of Glen Rock.  I understand that no refunds are possible if my child cannot attend.  Some scholarship money is available if the cost of the trip is difficult for some to provide.

My child has the following food and/or drug allergies:

____________________________________________________________________________________________________________________________________________________________

In the event of an emergency, I may be reached at the following phone number during Friday night and Saturday morning, October 8, 2011.

Home:  _________________            Cell:  ___________________Other:  ______________

Parent Signature:  _____________________________________________

Name: (please print):  __________________________________________

Address:  ___________________________________________________

Date:  ______________________________________________________

The Community Church of Glen Rock

354 Rock Road

Glen Rock, NJ  05452

201-444-4625