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Fall Retreat Registration
For STUDENTS and CHAPERONES!
***********COMPLETE BOTH STEPS!****************
STEP 1:  Fill out this form and submit it no later than October 17, 2019.
STEP 2:  Download the form found at this link - http://bit.ly/NYIRetreatWaiver  - print it, complete it, and bring it with you to the event. Parent/Guardian Signature is REQUIRED for anyone under 18.
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Email *
Your name
What grade are you in? (Adults choose "Chaperone")
What church are you from?
Home Address (House number and street)
City, State, ZIP
Phone Number
Parent/Guardian Name
Emergency contact phone
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