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Winter Retreat 2023 - High School on Friday, February 17, 2023 @ 5:00 PM

249.00

Additional Information

*Student grade:
*Gender:
*Birthdate:
*School:
*Campus my student attends weekly:
Parent/Guardian's Information
*Who does the student live with?:
Primary Parent/Guardian
*First Name 1:
*Last Name 1:
*Cell Number 1:
*Email 1:
Secondary Parent/Guardian
First Name 2:
Last Name 2:
Cell Number 2:
Email 2:
Student may also be release to the person(s) listed below:
Contact 1: (Name/Phone):
Contact 2: (Name/Phone):
Contact 3: (Name/Phone):
Go to 12Stone.com/winterretreat for a packing list, the required Student Ministry Participation Release form, and more information about Winter Retreat. 

All Parent Permission, Release, and Consent forms must be notarized and turned in by Sunday, February 5th.  Parent Meetings will be held at each campus on Sunday, February 5th at 5:00 PM.  Notaries will be available after all parent meetings.

We will have 2 Registered Nurses on our Winter Retreat for Students with medical concerns and any medical issues that arise.
Medical insurance coverage is required for every student attending.  Please enter your students current insurance information

*Subscriber Name:
* Provider:
*ID #:
*Group #:
*Provider Address and Phone Number:
I HAVE READ THIS DOCUMENT AND UNDERSTAND THAT ALL REGISTRATION PAYMENTS ARE NON-REFUNDABLE
*Digital Signature