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Middle School Youth Retreat
The Middle School School Youth Retreat will take place July 1st through July 3rd at Singing Hills in Plainfield, NH. Please note: there is a separate sign up for the High School Retreat.

Below you will find our online registration. Please fill out the family contact information at the top of the page then fill out the specific questions for each participant below. When completed, click the submit button at the bottom of the page.

Questions? Contact Robert Moore at robert.moore@christredeemerchurch.org.
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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
In case of emergency, first contact should be... *
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 *
We will be requiring all participants to either be vaccinated or have a negative COVID test and quarantine for the three days leading up to the portion of the retreat they are attending. *
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
We will be requiring all participants to either be vaccinated or have a negative COVID test and quarantine for the three days leading up to the portion of the retreat they are attending.
Clear selection
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
We will be requiring all participants to either be vaccinated or have a negative COVID test and quarantine for the three days leading up to the portion of the retreat they are attending.
Clear selection
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
We will be requiring all participants to either be vaccinated or have a negative COVID test and quarantine for the three days leading up to the portion of the retreat they are attending.
Clear selection
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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