MAD RETREAT - DEPTH: BELOW THE SURFACE
October 11-13th

Venue: Trout Lake
Jackson Township, PA 18360
https://goo.gl/maps/ZZG3MutAwJHXK7gt5

Investment: $200

Guest Speaker: João Lucas Figueiredo

PARENT/GUARDIAN INFORMATION
Father or Guardian’s Full Name *
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Mother or Guardian’s Full Name *
Your answer
Full Address *
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Parent Phone Number *
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Parent Email Address *
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Emergency Contact *
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STUDENT INFORMATION
Full Name *
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Cell Phone Number *
Your answer
Age *
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Grade *
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Gender *
Do you attend our youth group on Fridays? *
Have you been to our Retreat before? *
Do you have any food allergies? *
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Do you have any medical conditions or illness? If so, please describe *
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Are you currently taking any medications? If yes, what medication? *
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Is there anything else we should know?
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ATTENTION! Payment Info
Please click on this link to make your payment: http://bit.ly/madpayment
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