Youth Retreat 2019
Event Dates: July 10th-15th, 2019
Event Address: Lincoln State Park 15476 County Rd 300 E, Lincoln City, IN 47552
Cost: TBD

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Student's Name or Leader/chaperone name *
Student's Phone Number
Parent or Guardian's Name *
Parent or Guardian's Phone Number *
Parent/Guardian Email *
Student's Date of Birth *
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Student's Grade Level (going into) *
Will student be able to stay for the full duration of youth retreat? *
Does the student have any allergies we need to be aware of? *
Dietary Restrictions
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Shirt Size *
Does the student take any medications regularly? If so, please list name of medication, how often medication is taken, and dosage. *
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