Youth Belong Retreat 2025

February 21-23, 2025 | Please fill out this form and click submit.

Deadline to register and guarantee a t-shirt is Sunday, February 16

Parent Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Student Name

*

Grade

*

Please select one option.

6th 7th 8th 9th 10th 11th 12th

T-Shirt Size

*

Please select one option.

Youth - S Youth - M Youth - L Adult - S Adult - M Adult - L Adult - XL Adult - XXL

Student Name

Grade

Please select one option.

6th 7th 8th 9th 10th 11th 12th

T-Shirt Size

Please select one option.

Youth - S Youth - M Youth - L Adult - S Adult - M Adult - L Adult - XL Adult - XXL

Student Name

Grade

Please select one option.

6th 7th 8th 9th 10th 11th 12th

T-Shirt Size

Please select one option.

Youth - S Youth - M Youth - L Adult - S Adult - M Adult - L Adult - XL Adult - XXL

Allergies

*

Please select one option.

Yes No

Any Information the Youth Leaders Need to Know

Payment

1 student ($40.00) 2 students ($80.00) 3 students ($120.00) Full Scholarship ($40.00) Partial Scholarship ($20.00)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

February 21-23, 2025

Please fill out this form and click submit.

Deadline to register and guarantee a t-shirt is Sunday, February 16

Please Fix the Following

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