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Fall Youth Retreat Pre-Registration Form
Please complete one form per participant, INCLUDING ADULT SPONSORS.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Current Grade
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Adult/Sponsor
Birthday
*
MM
/
DD
/
YYYY
Gender
*
Your answer
Sponsoring Church (Include City/State)
*
Your answer
Home Address (Street, City, State, Zip)
*
Your answer
Phone Number
*
Your answer
Email Address
*
This email address will be used to send out the registration and health forms that ALL youth AND adults will need to print out and bring to Kamp with them in order to participate in the retreat. Please make sure that this is a valid email address.
Your answer
T-shirt Size (Adult Unisex Shirts)
*
Fall Youth Retreat t-shirts will be included in the registration price. Participants registered by the deadline will receive an event t-shirt.
S
M
L
XL
XXL
I am currently fully vaccinated against Covid-19
*
Yes
No
I am in the process of becoming vaccinated (one dose already received)
I will be fully vaccinated by October 1, 2021
Required
Vaccine Date and Type
*
Your answer
A copy of your responses will be emailed to the address you provided.
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