Jr. High Youth Retreat 2026

Name of Student

Name of Parent(s)

Contact me about being an adult chaperone!

Yes, I'm in! Not this time, but maybe next time. No, thank you!

This address will receive a confirmation email

Emergency Contact Phone #

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Eligible Students: Current Jr. High School Students

Jr. High School: Oct 2-4

Cost: $50/student

Please fill out the following form and submit it to register your student - one form per student. Nathan will follow up with you on any additional details.

Jr. High Youth Retreat 2026

Description

Please Fix the Following