Winter Retreat Registration

Church Registration Form - 2020

Meltdowns & Jr. FreezeOuts
This form is a church/group registration form. Individuals should contact their church to register, please do not use this form. Thank you!
Choose your Retreat:*
Contact Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Church & Church City*
Please include your church city!
Number of Girl Campers*
(If none, enter a zero)
Number of Boy Campers*
(If none, enter a zero)
Number of Girl Counselors*
(If none, enter a zero)
Number of Boy Counselors*
(If none, enter a zero)

T-Shirt Order Form!
Each camper & counselor gets a free t-shirt, if registered by the deadline!
Please choose your shirt sizes!
Youth Large
Adult Small
Adult Medium
Adult Large
X-Large
2-XL

Payment: Please be sure to enter the "quantity" for campers & counselors!*

Two Day Retreat - Counselors$25.00

Quantity

Two Day Retreat - Campers$55.00

Quantity

Three Day Retreat - Counselors$35.00

Quantity

Three Day Retreat - Campers$70.00

Quantity

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Church Registration Form - 2020