Commitment Form

I _____________ parent of _____________ with this

form commit to participating in the Escape 22 summer
trip to _______________. This form verifies our
desire to participate in the time and cost requirements
of the training, travel, and debriefing of this trip. I
realize that this form will allow Cornerstone to
purchase items that will be at cost to us regardless of
whether my High School student is able to go or not.

Parent’s Signature_________________ Date______

Student’s Signature________________ Date______

The purpose of this form is to let us know who is all in. We need to
get a jump start on buying tickets, getting materials, purchasing
insurance, etc. This gives us freedom to do so. Also if there is some
unforeseen reason the student is unable to go medically, death in the
family, sin issues, etc. we will refund whatever possible. If you have
any questions feel free to contact Stan Hayek at
stanhayek@gmail.com or by phone at 515-441-9080. Thanks.

Return to Cornerstone Office or to Stan Hayek by March 28, 2010

Your first $100 payment is due April 7th.