Youth STARS Retreat Registration
(Sacrifice, Trust, Adoration, Reconciliation, Service)

The goal of the STARS Retreat is: to celebrate God's love in Jesus Christ; to grow as one who knows Him and follows Him, and to shine the light of new life that Jesus gives in a setting of solitude, prayer, worship, and fellowship, using clear teaching and powerful inspiration. The retreat is January 12-15, 2018, and the cost is $200. To register, fill out the form below. If you have questions, please email stars@concordia.cc.

First Name *
Your answer
Last Name *
Your answer
Gender *
Street Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Email *
Your answer
State *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Grade Level *
T-shirt Size *
If you would like something other than your given name on your name tag, please note that here. *
Your answer
Please list any dietary allergies or restrictions *
If there are none, please put N/A in the box
Your answer
Please indicate if you have any special physical needs *
If there are none, please put N/A in the box.
Your answer
Is it okay to give your name to past retreat participants? *
Emergency Contact Information
Emergency Contact 1 Name *
Your answer
Emergency Contact 1 Home Phone
Your answer
Emergency Contact 1 Cell Phone *
Your answer
Emergency Contact 1 Email *
Your answer
Emergency Contact 1 Home Address *
Your answer
Emergency Contact 2 Name *
Your answer
Emergency Contact 2 Home Phone *
Your answer
Emergency Contact 2 Cell Phone *
Your answer
Emergency Contact 2 Email *
Your answer
Emergency Contact 2 Home Address *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Concordia Lutheran Church & School. Report Abuse - Terms of Service - Additional Terms