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2018 Summer Youth Retreat
Come join us for Christ Redeemer Church's 2018 Youth Retreat Sunday, August 5th to Friday, August 10th in Ocean City, New Jersey.  Students entering 7th through 12th grade are welcome!

Below you will find our online registration.  Please fill out the family contact information at the top of the page, then fill out the name, date of birth, entering grade and medical information for each participant you would like to register.  When completed, click the submit button at the bottom of the page.

Questions? Contact the Christ Redeemer Church office at office@christredeemerchurch.org or 603-643-5588.  
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Family Information
Family Name *
Home Address *
Email Address (of parent or guardian if a minor) *
If more than one parent should receive emails about this event, please include both emails here.
Information needed for those under 18
Parent/Guardian Name(s) *
Parent/Guardian Phone Number(s) *
Emergency Contact
Emergency Contact Name & Phone Number *
Required
Medical Information
Physician Name & Phone Number *
Dentist Name & Phone Number *
Medical Insurance Company *
Group #/ ID # *
Insurance Address & Phone *
First Participant Registration
First Participant's Name *
First Participant's Date of Birth *
First Participant is entering *
Date of last Tetanus Shot *
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this trip:
List current medication/dosage:
Anything else we should be aware of?
Second Participant Registration
Second Participant's Name
Second Participant's Date of Birth
Second Participant is entering
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this trip:
List current medication/dosage:
Anything else we should be aware of?
Third Participant Registration
Third Participant's Name
Third Participant's Date of Birth
Third Participant is entering
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this trip:
List current medication/dosage:
Anything else we should be aware of?
Fourth Participant Registration
Fourth Participant's Name
Fourth Participant's Date of Birth
Fourth Participant is entering
Date of last Tetanus Shot
List any pre-existing medical conditions or any food or drug allergies that would be pertinent for this trip:
List current medication/dosage:
Anything else we should be aware of?
Additional Information
Name of Friend who invited you
Submit
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