High School Spring Retreat Registration

High School Spring Retreat Registration Form - Please use this form to register your child for our February 3-5, 2023 High School Retreat. The cost of this retreat is $200.00 per child. A $50.00 deposit is due at the time of registration. The $150.00 balance is due by January 28, 2023.

CAPTCHA
Teen's Name*
First Last
Teen Cell Phone*
Teen Email*
Age*
Please enter a number from 13 to 19.
Date of Birth*
MM slash DD slash YYYY
T-Shirt Size*
School*
Grade*
Please enter a number from 9 to 12.
Do you have any food or drug allergies?*
- Yes
- No
Please list any food or drug allergies.*
Do you have any medical conditions?*
- Yes
- No
Please list medical conditions.*
Do you take an medications regularly?*
- Yes
- No
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*
Are you using this retreat as your Confirmation Retreat requirement?*
- Yes
- No