Youth Retreat Registration

Youth Retreat Registration 2022

* Indicates required field

Camper's Name *

First

Last

Grade Completed *

Gender *

Parent Name *

First

Last

Parent's Number *

Parent's Email *

Emergency Contact # 1 *

First

Last

Phone Number *

Emergency Contact # 2 *

First

Last

Phone Number *

Emergency Contact #3 *

First

Last

Phone Number *

Allergies/ Special Needs/ Medical Information/Other (Church Name) *

Photo Release:

GCC Ignite Youth Group has my permission to use my child's photograph publicly in retreat materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Parent Signiture *

First

Last

Date *

Submit

YOUR CART

Youth Retreat Registration 2022

Photo Release:

We Would Love To Have You Visit Soon!