Retreat Registration Form

Retreat Sign-Up Form

Welcome! To sign-up your child for our next retreat, please complete and send this form to Kevin via the send button at the bottom. 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

Please provide the following contact information:

(First ) Child's Name
Date of Birth (mo/day/yr)
Age
Grade In School
Health Form On file With Us?
(Second) Child's Name
Date of Birth (mo/day/yr)
Age
Grade in School
Health Form On file With Us?
First Parent's Name
Second Parent's Name
Street Address
City
State
Zip/Postal Code
Home Phone
Cell Phone
Meeting Attended
E-mail

Please enter today's date:

-- month/day/year

Anything else you want us to know?

Please submit your form. We are honored to have your child/children with us on retreat.

Kevin Lee, JYM Retreats