Youth Fall Retreat

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Youth Fall Retreat

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* Indicates required question

Student First Name: *

Your answer

Student Last Name: *

Your answer

Student Phone Number *

Your answer

Grade Student is entering: *

7th

8th

9th

10th

11th

12th

Adult Leader

Parent First Name *

Your answer

Parent Last Name *

Your answer

Parent Phone Number *

Your answer

Address *

Your answer

City *

Your answer

Emergency Contact Name (different than above) *

Your answer

Emergency Contact Phone Number (different than above) *

Your answer

Allergies *

None

Other:

I understand that my student will not be officially signed up until they have paid for this event. *

Yes

I understand I need to sign a medical waiver for 2022 if they have not done so already. *

Yes

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