Fall Retreat 2019 - Registration Form

    Deadline to register is September 22nd.
    Early Bird Rate: $140 until Sept. 15th / Regular Rate: $165 (9/16-9/22)
    • RETREAT PARTICIPANT INFO
    • First Name
      Last Name
    • PARENT INFO
    • First Name
      Last Name
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    • ADULT VOLUNTEERS - The retreat is one of our larger events of the year and it requires a lot of parental involvement! (And it's lots of fun, too.) Please let us know how you are willing to help.
    • First Name
      Last Name
    • EMERGENCY CONTACT INFO
    • First Name
      Last Name
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    • SPECIAL DIETARY NEEDS FOR RETREAT PARTICIPANT?
    • PARENT AGREEMENT
    • By submitting this form I agree that my son/daughter has permission to participate in the LUMC Youth Fall Retreat at Triple R Ranch in Chesapeake on October 11-13, 2019. I understand that the full fee ($140 Early Bird Rate by 9/15 or $165 Regular Rate after 9/15) is due at the time of application by check payable to LUMC Youth. Fees may be given to Marlene Passarelli or dropped off in the Church Office. If I have not already done so, I will complete ASAP a 2019-2020 "Parental Consent, Medical Emergency & Liability Release Form" for my child, as well as the Triple R Release of Liability Forms for the Challenge Course & Horse Riding and our LUMC Youth Code of Conduct, all of which can be found on the Youth website (www.lumcvb.org). Forms are due no later than 9/22 which is also the registration deadline.