Youth WeekEnd Retreat Application Form

1- Full Name *
1- Full Name
2- Gender
Select
3- Date of Birth
3- Date of Birth
4- Address
4- Address
5- Home Phone
5- Home Phone
6- Mobile Phone
6- Mobile Phone
8- Mother's Name
8- Mother's Name
9- Mother's Mobile Phone
9- Mother's Mobile Phone
11- Father's Name
11- Father's Name
12- Father's Mobile Phone
12- Father's Mobile Phone
14- Emergency Contact Name
14- Emergency Contact Name
Please list the name of an individual other than any that you enter previously above.
15- Phone Emergency contact Phone
15- Phone Emergency contact Phone
Indicate the type of relationship the participant have with the Emergency contact, exemple: uncle, Brother etc...
Indicate the Name of the church of the Applicant
Indicate the Name of Applicant's pastors
indicate the Pastor's address
20- Pastor's Phone Number
20- Pastor's Phone Number
On the space below or via a separate email share your testimony of how you came to know the Lord and share how your walk with him is currently.
This youth retreat is a six session program that will take place January 5-7 & 19-21, February 2-4 & 16-18, and March 2-4 & 16-18
Please Indicates food allergy only... (If you have food preferences please do not put this as anallergy- we are aiming to make the weekend as cost effective as possible so that you can be better equipped for God’s kingdom and your personal walk with him.)