High School Retreat Registration Form
Student's Name
*
First Name
Goes By Name
Last Name
Grade:
*
Grade
Parent's Name
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Student Phone Number
Please enter a valid phone number.
Parent Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Student Release Form for 2025-26
There is a current release form on file for my student for 2025-26
I will complete and return to Student Ministries a new release form for my student
My Products
*
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HS Retreat 2025 Registration
(Grades 9-12)
$
250.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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