LCS - LCM Youth Retreat - Registration Form
LCS : Lutheran Church In Singapore
LCM : Lutheran Church in Malaysia
Email address *
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)
Congregation *
Personal Particulars
Name as in Passport *
Your answer
Your answer
Birthday *
Gender *
Mobile Number *
Your answer
Home Address *
Your answer
Postal Code *
Your answer
Schooling/Working *
Medical History/Allergy (if any) *
Dietary Restrictions (if any) *
eg. vegetarian, no seafood, no nuts, no......
Camp Fee
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)
Please ensure your passport has at least six months’ validity on the day of departure. (ie. 27 May 2018)
Passport Number *
Your answer
For emergency contact
Name of Next-of-kin *
Your answer
Relationship to Participant *
Your answer
Contact Number *
Your answer
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.

Thank you
Are you below 21 years-old? *
Please indicate Email Address to receive Parental Consent Form
Your answer
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.
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