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
Pomona, CA
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. *
What is your name? (First, MI, Last) *
Your answer
Address (Street, City, State, Zip Code) *
Your answer
What is your cellphone number? (xxx-xxx-xxxx) *
Your answer
What is your email address? *
Your answer
Emergency Person Name (First & Last) with contact number *
Your answer
What is the name of your Church? *
Name of your Youth Advisor (First, Last)
Your answer
What is your Grade in school, Fall 2019? *
Do you have any allergies or dietary restrictions? *
Your answer
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