Youth Mentorship Winter Retreat

Registration

Name

First Name

Last Name

Birthdate

YYYY

Highschool

Grade

What grade will you be in the coming school year.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Please indicate your participation

Will you be staying overnight at the facility, or attending during the day?

Parent's Name

First Name

Last Name

Parent Phone Number

(###)

###

####

Dietary Restrictions

Please list any dietary restrictions.

Message

Please provide any additional information or note if you have any questions.

Do you have a ride to the camp?

Yes

I would like to be connected to someone driving up to the camp

I can drive others to the camp as well

Financial Support Form

These mentorship retreats aim for the inclusivity of all youth that have the desire to serve.