Winter Retreat 2020 Registration

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Dates: March 20-22, 2020
Cost: $110 | $60 deposit due February 18th
Location: Pine Trail Camp in Sagautuck, MI
Speaker: Pastor Cornell Jordan
For Youth (6th grade - 12th grade) + Young Adults (College age & older)

For questions + concerns, please contact Pastor Joyann at joyann.ainley@gmail.com or call/text at 708-655-8171

(**Please note: If you are an adult filling out this form for yourself, please fill out the Parent/Guardian e-mail & phone number as your own)

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E-post *

Name of Student *

Parent/Guardian** Email *

Parent/Guardian** Phone Number *

Student Address *

Emergency Contact Name & Relation to Student *

Emergency Contact Phone Number *

Medical Insurance Information (Carrier & Policy #) *

Shirt Size *

XXL

Dietary/Allergy restrictions *

None

Vegetarian

Vegan

Gluten-free

Övrigt:

Obligatorisk

Medical conditions and/or medicine that the student has/takes that we should be aware of *

Payment *

I have paid the deposit or full cost online (can go to mchapel.net & click "Give Online" button)

I have submitted my payment (with cash or check) in person

I have not paid my deposit yet (PLEASE DO SO ASAP)

I have earned scholarship money

Övrigt:

Obligatorisk

I have submitted a SIGNED permission slip *

Yes

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