2024 Confirmation Retreat Registration

Confirmation Retreat Registration Form – Please use this form to register your child for our February 3-5, 2024 Confirmation Retreat at Hidden Lake in Dahlonega, GA. The cost of this retreat is $225.00 per child. A $50.00 deposit or full payment is due at the time of registration. Payment in full is due by January 15, 2024. All funds are non-refundable after January 22, 2024.

"*" indicates required fields

Teen's Name*

First Last

Teen Cell Phone*

Teen Email*

Date of Birth*

Age*

Please enter a number from 13 to 19.

T-Shirt Size*

School*

Grade*

Please enter a number from 8 to 12.

Do you have any food or drug allergies?*

Yes

Please list any food or drug allergies.*

Do you have any medical conditions?*

Yes

Please list medical conditions.*

Do you take an medications regularly?*

Yes

Please list any medications and instructions.*

Is there anything else we should know?*

Address*

Street Address Address Line 2 City State ZIP Code

Mother's Name*

First Last

Mother's Cell*

Mother's Email*

Father's Name*

First Last

Father's Cell*

Father's Email*

Emergency Contact (other than parent)*

First Last

Emergency Contact Relationship to Teen*

Emergency Contact Cell*

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Name

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