Winter Blast Teen Retreat Registration Form with Payment

Winter Blast Teen Retreat

Please register your Youth Group by filling the form below.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Church
Church Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
First Time Attending?

YESNO
Download the Waiver of Liability. Each participant must have a parent or legal guardian sign this form. Bring to registration on Friday.*
Download the Health Form. Each participant must have a parent or legal guardian complete this form. Bring to registration on Friday.
Download the What to Bring Handout. Make copies for each participant.
Payments are processed through Square. We will accept major credit and debit cards.

Beginning October 25, 2025 there will be a 3% fee for credit/debit card charges on all purchases.
Options for payment

I will pay with a credit card nowI will pay upon arrivalI will pay over the phoneI will send a checkOther
Cost is $175 per guest. Please select the estimated size of your group. A $10 deposit per participant is required to register your church or group.

1-10 participants11-25 participants26-40 participantsover 41

Costs for Retreat

Number of ParticipantsDeposit Only

$10.00 Quantity

Number of Participants Pay in Full

$175.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00