ANTIOCH RETREAT

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Parents! Volunteers are always needed during these weekends.... we cannot get the retreat off of the ground without your assistance! Please select the ways in which you are able and willing to help. It is GREATLY appreciated!

Parent Volunteers Needed:

Please choose all that apply.

Saturday Breakfast Saturday Lunch Saturday Dinner Sunday Breakfast Sunday Lunch Make/Bring Salad Make/Bring Dessert

Teen Staying Overnight REQUIRED

To ehance retreat experience, the teens remain at Christ the King during the entire weekend.

Yes No Please fill out this field.

Air Mattress

If teen is staying over, please indicate if you have an air mattress

Yes No

T-Shirt Size Small Medium Large XL

Confirmation Sponsor's Name REQUIRED Please fill out this field. Please enter valid data.

Confirmation Sponsor's Email Address REQUIRED Please fill out this field. Please enter valid data.

Teenager's Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.

Teenager's Email Address REQUIRED Please fill out this field. Please enter valid data.

Teenager's Chosen Confirmation Name REQUIRED Please fill out this field. Please enter valid data.

Current Medications Please enter valid data.

Any Concerns REQUIRED

Please indicate any medical concerns or allergies.

Please fill out this field.

ANTIOCH RETREAT

ANTIOCH RETREAT REGISTRATION FORM
(January 13-15, 2017)

SAVE THE DATE!

For more information contact: