High School Girls Retreat Registration 2024

Emergency Contact

Name(Required)

First Last

Relationship to Participant(Required)

Home Phone #(Required)

Cell Phone #(Required)

Email(Required)

Pediatrician Name(Required)

Pediatrician Phone Number(Required)

Any medication that participant will take during the weekend: If Yes, include the medication name and how and when its taken during the weekend.(Required)

Any known allergies (food or medication)

Parent/ Guardian sign below to agree to the Health and Safety and Photo Release Waiver:(Required)

Coupon

Payment Options(Required)

Full Payment $225

Recurring Payment of $75 for 3 months

Recurring Payment of $37.50 for 6 months

Sponsorship Opportunities

Total

Credit Card(Required)

Name

This field is for validation purposes and should be left unchanged.

High School Girls Retreat 2024

Registration Form

Parent/ Guardian Info 1

Parent/ Guardian Info 2

Emergency Contact