Use the form below to sign up for our Youth Retreat. Places are limited. To make sure you get a place, sign up now!

PLEASE NOTE: YOUR PLACE IS NOT CONFIRMED UNTIL A DEPOSIT HAS BEEN RECEIVED

Name *
Name
Please let us know of any special dietary requirements you have.
Are you Currently Taking any Medication *
List all medical conditions.
Emergency Contact Name 1 *
Emergency Contact Name 1
Address 1 *
Address 1
Emergency Contact Name 2 *
Emergency Contact Name 2
Address 2 *
Address 2
Doctor's Name *
Doctor's Name
Doctor's Address *
Doctor's Address
Parental Consent (if under 18) *
I have read the terms and conditions of this event and confirm I wish my son/daughter to attend.
Parent's Name *
Parent's Name
Form Completion Date *
Form Completion Date
Photo Policy and Guidelines *
You are joining the Youth Service on this trip and are expected to abide by the guidelines and rules given. By checking the box below you confirm your agreement to the terms and conditions, photo policy and guidelines set out on the website.