2019 Teen Winter Retreat Registration Form

2019 Teen Winter Retreat

If you are human, leave this field blank.

First Name *

Last Name *

Address *

(Street, City, State, Zip)

Phone *

(xxx-xxx-xxxx)

Email *

(To receive confirmation of registration.)

Gender *

Date of Birth *

(DD/MM/YY)

Grade *

Home Church

Parent/Guardian Name(s) *

Emergency Contact Person *

Emergency Contact Person'sPhone *

(xxx-xxx-xxxx)

Medical / Personal Notes

Having read the CLAY Winter Retreat flyer, I agree to allow my youth to attend. I relinquish New Life Church, Abba's Haven, volunteer workers and anyone associated therein of any liability described within the brochure. *

Pay *

Online Now

Cash Later

PLEASE CLICK HERE to open a separate online payment page.
AFTER YOU HAVE COMPLETED YOUR PAYMENT, you must then click the "SUBMIT" button below on this page in order to complete your registration.

Type any extra information here: