The Fall Out Retreat
Event Address: Agape Wilderness Retreat 831 Barebone Rd, Bedford, KY 40006
Contact us at (513) 435-7282 or

We are so excited to have you join us on our retreat! This form is a SIGN UP form. By filling out this form you are making a reservation for The Fall Out Retreat. Once we have received your sign up information we will send you a confirmation email with further details. If you do not receive a confirmation email from us, please email us at the above address to confirm your place.
Name of attendee: *
Your answer
Parent's email address: *
Your answer
Do you understand that the cost for this retreat is $110. This includes all meals EXCEPT for lunch on the way home on Sunday. (Send $10 cash with your child for lunch on Sunday) *** We will be offering 2 different fundraisers to help lower the costs of the retreat. More information will be sent in the confirmation email. *
In order to finalize your reservation, a deposit of $25 is due by the following Thursday. Checks payable to "The Village Church". *
Name of person filling out this form: *
Your answer
Relationship to attendee: *
Your answer
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