LCS - LCM Youth Retreat - Registration Form
LCS : Lutheran Church In Singapore
LCM : Lutheran Church in Malaysia
Date : 27 Nov 2017 (Monday) to 29 Nov 2017 (Wednesday)
Venue : Malaysia Bible Seminary (KL)
Address : Lot 728, Jalan Kundang, 48050 Kuang, Selangor Darul Ehsan, Malaysia
Fee : $50 per Pax (Registration Closing Date : 10 Sept 2017)
Bedok Lutheran Church
Jurong Christian Church
Lutheran Church of Our Redeemer
Queenstown Lutheran Church
Yishun Christian Church (Lutheran)
Name as in Passport
Tertiary (ITE, JC, Poly, Uni,etc...)
Medical History/Allergy (if any)
Dietary Restrictions (if any)
eg. vegetarian, no seafood, no nuts, no......
If you need subsidy, please approach your leader. Please note that subsidy will be given to those in need. (Individual Participant S$50; Local Congregation S$50; LCS S$50)
I need subsidy. (Please discuss with your church Youth Worker/Leaders)
Please ensure your passport has at least six months’ validity on the day of departure. (ie. 27 May 2018)
For emergency contact
Name of Next-of-kin
Relationship to Participant
Parental Consent (For participants under 21 years of age)
A Parental Consent Form will be emailed to you.
Please indicate your email below.
Please [PRINT] and [SIGN] and [SUBMIT] the email to your leader upon making payment.
Are you below 21 years-old?
Yes, please indicate your email below.
Please indicate Email Address to receive Parental Consent Form
Singapore Personal Data Protection Act 2012 (PDPA)
By filling up and submitting this form, I give consent to Lutheran Church in Singapore - LCS Youth Committee to collect, use, retain, and disclose my personal information to LCS' authorised service providers and ministry partners for administration and communication purposes.
I give my consent
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service