Registration Form - Family Retreats

Please print registration form (one form per person) and mail or fax to 863.696.1062
If you prefer, you may fax your registration form and pay on-line using our secure server.
(Just use the Registration box for fees to be paid - it will appear as a 'donation' but it is a payment)

Mother/Daughter or Father/Son Registration

Adults Name:_____________________________________________________

Childs Name(s):___________________________________________________

        Age(s):_____________________________________________________

 (All ages are welcome. However, past participants recommend at least 4 years and up as activities are geared more to interactive ages. Child - 5-18 years old. Call or email for rates under 5 years of age.)

Address:__________________________________________________________

              ____________________________________________________________

City:__________________________________ St:_______ Zip:_________________

Phone: (include area code)____________________________________________

email address:______________________________________________________

Home Church/City:__________________________________________________

_____Mother & Daughter Retreat       October 5-6, 2018 ($54 adult/$38child)
_____ Sponsor a table decoration in retreat theme (You will be given instructions)
_____Father & Son Lakeside Retreat      Nov. 16-17, 2018 ($54 adult/$38child)
_____ Paintball Option: Add $20 and Waiver Signature
_____Optional Camp Out Extension        Nov. 17-18, 2018   Add: ($28 adult/$17 child)
_____ Father/Son Spring ReConnect 2019 TBD ($40/24)Pre-requiste - attended Fall 2018 retreat

$ Amount Enclosed:_______________________       $50 deposit per retreat or full payment.

Charge to:     Mastercard      Visa    American Express      Discover
   

CC #______________________________________________________exp. date______
3 digit security code: _________

Authorized Signature:____________________________________________________

Name on card: ___________________________________________________________

Billing address of cardholder if different from above:
Street:______________________________________________
City:________________________________________________
ST:___________Zip:___________________________________
Phone of card holder: __________________________________________________

Deposit is transferable but not refundable.