JYM Retreat Registration Form-Via Email

Special Note:
We regret to inform parents that due to the soaring costs of food and other retreat related expenses, NEYM Youth Program's Committee has increased our fees to $60 beginning in Sept. 08 for both JYM and JHYM retreats. We dearly regret having to do this but we had no other choice. Please remember that scholarship assistance is available on an as-needed basis. Please don't hesitate to request it.

Welcome! Please follow the recommended sign-up times listed on the Scheduled Retreats page. Please register for one retreat only. You will receive an email confirmation note (on average) three weeks before the retreat weekend. Please understand that registration is on a first come basis. If the retreat fills, and most do, I will send you notice that your child has been placed on a wait list. Thanks again.  - Kevin 

 

To use this form to sign your child up for the next JYM Elementary 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 Kevin Lee.
  3. Paste the form into the email that will open addressed to Kevin.
  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.

Kevin Lee

                                                                                                                             ↓  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  
Health Form On File With Us? (yes/no)  
First Retreat With Us? (yes/no)  
   
Second Child's Name (If needed)  
Date of Birth (mo/day/yr)  
Age  
Grade in School  
Health Form On File With Us? (yes/no)  
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)  
Is your child a vegetarian? Yes/No  
Is your child a vegan? Yes/No  
Any dietary restrictions that we should know about? If "Yes" please detail below.  
Notes: