CANA Week 2021 Registration

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June 19-25 Hartstone Bible Camp, Potter Valley, California

Spouse #1 Full Name *

Spouse #2 Full Name *

Spouse #1 Email Address *

Spouse #2 Email Address *

Spouse #1 Phone Number (Mobile)

Spouse #2 Phone Number (Mobile)

Family Address (STREET ADDRESS, CITY, STATE, ZIP)

Date of Marriage

Will you bring children to the retreat? *

yes

Please list name, age, date of birth and gender of each child

How did you hear about the Cana Week?

Church membership/affiliation, if any?

Dietary restrictions or other important information or accommodations

For everyone's health and safety, we will be asking participants 16+ to be fully vaccinated to attend. Youth 12-15 vaccinations recommended (but not required). Current CDC guidelines will be adhered to (masking and social distancing if necessary, dependent on county health directives and COVID-19 risk.) Given these requirements and safety protocols, would you like to attend CANA Week 2021?

Yes

Maybe

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Do you have any additional questions or comments?

Submit

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