Young Adults Retreat Registration

Name*

First Last

Email*

Phone*

Transportation*

Church Bus/Van
Driving on own

Driving with?

I have room for more people.*

Yes
No

How many more can you take?*

Emergency Contacts

Allergies/Dietary Restrictions

YA Retreat Registration*

Price:

I would like to donate funds towards a scholarship. Please indicate amount.

Total

$0.00

Credit Card

Card Details

Cardholder Name

Terms and Conditions

Media Liability Release: By registering, I am giving Grace Chapel permission to use images, videos, or quotes taken of me/my children in promotional materials, in the newsletter, on the website, or in any capacity for any use in perpetuity.