Youth Fall Retreat 2025 Registration Form

Youth Information:

Name

Mobile Phone

Parent Information:

Name

This address will receive a confirmation email

Mobile Phone

Additional Information:

Allergies:

Medications:

Payment:

Payment: Enter $130.00

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

September 12-14

The Fall Retreat is at Camp Nuhop in Perrysville, Ohio. All meals will be covered throughout the weekend! Including breakfast on Sunday.