PLEASE FILL OUT THE FORM TO REGISTER
FOR FALL RETREAT

Our retreat will take place on October 28th through October 30th at Mercy Crossing and is free to all students. We can’t wait to see all that God is going to do in our student’s lives through powerful worship services, fun and creative games and activities, and engaging messages.

Student Name

First Name

Last Name

Student's Phone Number

(###)

###

####

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone Number

(###)

###

####

Middle or High School Student

Middle School

High School

Dietary Restrictions/Allergies

Please list any food allergies, dietary restrictions, etc that we need to be aware of.