Lent Retreat Registration Form
Friday, March 13 5:00-7:00PM (Dinner provided)
Sat. March 24 9:00am-1:15pm (Lunch provided)

Only one registration form per household is needed.  Please fill in information for each person from your household who will be attending the retreat.  
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Email *
Adult #1 attending from your household *
Adult #2 attending from your household
Child #1 attending: Name and Age
Child #2 attending: Name and Age
Child #3 attending: Name and Age
Select which retreat dates registrants will be attending *
Required
Dietary restrictions or preferences *
For parents/guardians registering children, this retreat aims to provide opportunities for both adults and children.  It is our hope that you will attend with your children.  Children will go to age specific groups (children 5+) or the nursery (children under 4) for learning time, but will be with you for meals.  Please click the check box below to indicate that you will be attending and available to help your children during meal times.
Photo Release Form: I,  hereby grant, voluntarily and with full understanding, to Chapel in the Pines Presbyterian, a license to the following: 1. Use and storage of my child’s or my name and image, by means of digital or film photography, video photography, audio recording or other documentation, with respect to the activity, Lent Retreat. 2. Use of any stored data including my name and image in printed publications of Churches. 3. Use of any stored data including my child's or my name and image in electronic publications of Churches. 4. Use of any stored data including my child's or my name and image in any Web site created by or for Churches for its sole benefit. 5. If I am signing this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of the child. 6. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If I cannot agree with Church upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution. *
To help off-set the costs of this retreat (including meals and materials). CITP is requesting a $10 donation from each household attending the program.  Please follow the link below to make your payment online .  When you reach the pull down menu designating where the payment should be credited, select "Lent Retreat".  Online Payment: https://onrealm.org/ChapelInPines/-/give/WNAYSSAUDV *
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