Middle School Summer Mission Week 2021

Register Now!

Middle school students, completing grades 6-8

 Sunday, July 11 - Thursday, July 15

 Each day beginning at Peters Creek Baptist Church

 With continued virus awareness in mind as we planned this year’s Youth Summer Mission -- as well as the success of last summer’s “home-based” mission work -- we will once again be holding our Middle School Summer Mission Week with Peters Creek as our home base.  As always, our major focus each day will be working on homes in the community for people who are in need of a little help. We will spend our evenings back at Peters Creek, reflecting on the day and making time for praise and worship before heading home for the night and coming back bright and early the next day.  An added feature this year will be an outing to Sandcastle Water Park on Thursday.

How much:
 The price is $110 for the week, and this will cover the cost of food, daily transportation, Sandcastle admission, and, of course, a t-shirt.

The sign-up deadline for the Middle School Summer Mission Week is June 30th.  As always, please do not let financial issues keep you from attending.  You are more important than the money!

Still have questions?
 Contact Pastor Dave or call the church office at 412-833-6111.

Due to the nature of this experience, please be aware that late drop-offs and early dismissals must be coordinated in advance and are not encouraged.

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Permission for Emergency Medical Treatment:
By submitting this registration form, I do hereby give my permission for emergency medical treatment to be administered to the person who is the subject of this form.  I understand that all reasonable attempts will be made to contact me as soon as possible after the condition necessitating treatment arises and that, failing to reach me, all reasonable attempts to reach the person listed below as the emergency contact will be made.  I understand that every precaution will be taken for safety at all times.  I further release Peters Creek Baptist Church and their representatives or sponsors from liability associated with any accident, injury, or disease to the person who is the subject of this form.


Paying Now or Later?

Student Information

*First Name
*Last Name
Apartment If Applicable
*Zip Code
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Birthdate (mm/dd/yyyy)

Parent/Guardian Information

First Name
Last Name
Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Health Information

Health Insurance Company
Health Insurance Policy Number
*Known Health Issues
*Allergies and any medication you will be taking during the event

Emergency Contact Information

*First and Last Name
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Grade & Shirt Size

Grade 2020-2021
Shirt Size

*Electronic Signature

*Participant Electronic Signature
*Parental Consent, by signing this I agree that I am the parent/guardian of this participating youth


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6300 Library Road | South Park, PA 15129
(412) 833-6111