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Winter Refresh Sign-up Form 2026
Thank you for signing up to join us on our 2026 Winter Refresh Retreat for Middle School and High School Youth! We look forward to having you join us this February 20-22 in Gretna Glen, Lebanon PA.
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Grade:
Grade:
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6th
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Youth phone number (if they have one):
Youth phone number (if they have one):
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Emergency contact name:
Emergency contact name:
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Emergency contact relation:
Emergency contact relation:
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Emergency contact phone number:
Emergency contact phone number:
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Emergency contact email:
Emergency contact email:
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Please list any allergies or dietary restrictions here. This could be food/environmental allergies or dietary needs such as vegetarian, gluten free, etc. (If none, you may skip this question.)
Please list any allergies or dietary restrictions here. This could be food/environmental allergies or dietary needs such as vegetarian, gluten free, etc. (If none, you may skip this question.)
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Please list any medications that here. This could include EpiPen's, inhalers, insulin, etc. (If none, you may skip this question.)
Please list any medications that here. This could include EpiPen's, inhalers, insulin, etc. (If none, you may skip this question.)
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The cost of this trip is $215.
Checks can be written out to "First Presbyterian Church of West Chester" with "Winter Refresh" in the memo line. Online payments can be made here: LINK (Choose one time payment/ HS or MS Youth Trips) How should we look out for your payment?
The cost of this trip is $215.
Checks can be written out to "First Presbyterian Church of West Chester" with "Winter Refresh" in the memo line. Online payments can be made here: LINK (Choose one time payment/ HS or MS Youth Trips) How should we look out for your payment?
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Online
Check
Cash
Contact me about scholarship opportunities
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If the participant is under 18 and has medication, would you like an adult leader to hold their medicine?
If the participant is under 18 and has medication, would you like an adult leader to hold their medicine?
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Yes
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If you have any questions about the trip, please submit them here. Otherwise, you may skip this question.
If you have any questions about the trip, please submit them here. Otherwise, you may skip this question.
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Please upload a photo of the front and back of your child's insurance card. (If we have that info from the Philly Project trip or fall retreat and it has not changed you do not need to provide this.)
Please upload a photo of the front and back of your child's insurance card. (If we have that info from the Philly Project trip or fall retreat and it has not changed you do not need to provide this.)
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