NewStory Youth Winter Retreat Registration
RETREAT INFORMATION:
Dates: Friday, February 15, 2019 - Monday, February 18, 2019
Location: Tahquitz Pines - 55251 South Circle Dr., Idyllwild, CA 92549
Location Phone: 951-659-2934
Cost: $180*
* Sibling discount available! $10 off for 2nd child, $15 off for 3rd
STUDENT INFORMATION
First and Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade
Sweatshirt Size
Allergies or Dietary Restrictions
Your answer
PARENT INFORMATION
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Contact Phone Number *
Your answer
Parent/Guardian Email *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
INSURANCE
Health Insurance Company
Your answer
Policy Holder Name
Your answer
Health Insurance Policy Number
Your answer
Physician Name and Phone Number
Your answer
Check all that apply: *
Required
I have read the above and agree to its terms and conditions. Furthermore, should it be necessary for my child to return home due to medical, disciplinary, or otherwise, I hereby assume all transportation costs. *
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