Father Heart "A": School Buffalo

Place: HARBOR LIGHTS Address:1821 Grand Island Blvd., Grand Island, NY 14072 Dates: February 17-23, 2019 Contact: Matthew Haberstro mats461@gmail.com

Contact Info





Application

Please answer the following questions as honestly and openly as you can. All answers will be treated in the strictest confidence.


General Health


Fee

Total Fee $475.00 Less Registration Fee $100.00 (Non-Refundable) due with application. Balance $375.00 (due no later than one week before school begins) You may pay the entire $475.00 now if you choose. Add $50 for special diet due at registration.

Personal Expenses

All personal expenses are your responsibility: i.e. additional personal transportation, flights, supplies, phone calls, medical fees, spending money and laundry expenses.

Release of Liability

By completing this form I agree to release Fatherheart Ministries, its staff, agents and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss sustained by myself during the course of involvement with Fatherheart Ministries, and I certify that all the information in this application is complete and accurate.Type Name Below and Date.