PSWD CoB: Summer Youth Retreat 2019
Let us begin this summer by including in God in our plans for the coming year!
Saturday, June 29th 10am-5pm
Register Online BEFORE JUNE 15th
Submit: Fill this form out + send signed documents/permission slips
After Registering, Complete the permission forms and mail cash/check of $5 payment before June 23rd to P.O. Box 219 La Verne, CA 91750-0219 to attend.
I understand that if my permission forms and payment are NOT submitted, I cannot attend Summer Youth Revival
What is your name? (First, MI, Last)
Address (Street, City, State, Zip Code)
What is your cellphone number? (xxx-xxx-xxxx)
What is your email address?
Emergency Person Name (First & Last) with contact number
What is the name of your Church?
Centro Agape en Acción, Los Banos
Iglesia de Cristo Sion, CoB, Pomona
Principe de Paz CoB, Santa Ana
Journey South Bay
La Verne CoB
Live Oak CoB
Name of your Youth Advisor (First, Last)
What is your Grade in school, Fall 2019?
Graduated H.S., Class of 2019
Do you have any allergies or dietary restrictions?
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