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Junior High Yearly Meeting Retreat Registration Form

Please complete and send to sign up for our next JHYM Retreat. Retreat sign ups are on a first-come basis. When we move to a wait list you will be notified promptly. An updated Health and Safety Form must also be on file at the beginning of the retreat.  

To use this form to sign your child up for the next JHYM Retreat, please follow these steps:

  1. Copy the entire form below.    (How? Left click and scroll over entire Form, then right click, and choose copy)
  2. Click > Email Form to Gretchen Baker-Smith
  3. Paste the form into the email that will open addressed to Gretchen.
  4. After you copy it to your email, complete the form. ☺
  5. When the form is completed, send it to me!

After you send the Form using email, this page reappears. You're done! Thank you.

Gretchen Baker-Smith

                                                                                                                             ↓  Copy Form ↓ 

Step 4: Complete Form  | Step 5: Send Completed Form
First Child's Name  
Date of Birth (mo/day/yr)  
Age  
Grade in School  
Is this child taking any meds that we need to be aware of? (yes/no) If yes, please detail in notes below. Thanks!  
First Retreat With Us? (yes/no)  
   
Second Child's Name (If needed)  
Date of Birth (mo/day/yr)  
Age  
Grade in School  
Is this child taking any meds that we need to be aware of? (yes/no) If yes, please detail in notes below. Thanks!  
First Retreat With Us? (yes/no)  
   
First Parent's Name  
Second Parent's Name  
Street Address  
City  
State  
Zip/Postal Code  
Home Phone  
Cell Phone  
Meeting Attended  
Parent's Email Address (Required)  
Retreat attenders email address
(If available)		  
Notes: