2019 Teen Winter Retreat Registration Form

2019 Teen Winter Retreat

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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 Brochure, 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

BEFORE YOU SUBMIT REGISTRATION 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.

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