Youth STARS Retreat Team Registration
PLEASE NOTE THAT ALL RESPONSES SUBMITTED AFTER 9/26 WILL BE PLACED ON A WAITLIST.

(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.

Participant Information
First Name *
Your answer
Last Name *
Your answer
Street Address 1 *
Your answer
City *
Your answer
Zip Code *
Your answer
State *
Your answer
Street Address 2
Your answer
Email *
Your answer
Cell Phone (XXX-XXX-XXXX) *
Your answer
Can you receive texts? *
Gender *
Are you on Facebook? *
Date of Birth *
MM
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DD
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YYYY
T-Shirt Size *
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
Briefly describe why YOU would like to serve on the STARS team. *
Your answer
If you are chosen to serve on the team and you are willing to share your testimony, please provide a short paragraph about it. *
Your answer
Briefly describe how your strengths will positively impact other STARS team members and retreatants. *
Your answer
Medical Information
Physician's Name *
Your answer
Physician's Phone Number (XXX-XXX-XXXX) *
Your answer
Are your immunizations current? *
Your last Tetanus/Diphtheria immunization was on: *
Your answer
Special Needs or Dietary Restrictions? *
Your answer
Would you be able to attend the 10 retreat meetings leading up to the retreat, and remain at the retreat center during the entire weekend? *
Please select your preferences to serve:
SERVICES

Messengers/Angels
- This group meets all of the needs of the retreatants during the weekend.
Deacons/Deaconess
- This group is in charge of all food and beverage needs of the retreatants.
Table Leaders/Assistant Table Leaders
- Responsible for leading and facilitating discussion at tables throughout the weekend.

SERVICES Choice #1 *
SERVICES Choice #2 *
SERVICES Choice #3 *
Please select your ministry preference:
MINISTRIES

Passion
- This is a live drama of Christ's final steps to the cross.
Upper Room
- This is a live drama of the Last Supper.
Agape
- This is a light meal (bread, cheese, grapes, and grape juice) and an evening of fellowship. It is a time for retreatants
to share what the weekend has meant to them.

MINISTRIES Choice #1 *
MINISTRIES Choice #2 *
MINISTRIES Choice #3 *
Parental/Guardian Information
Parent/Guardian's Name *
Your answer
Home Phone Number (XXX-XXX-XXXX) *
Your answer
Cell Phone Number (XXX-XXX-XXXX) *
Your answer
Relationship to Participant *
Your answer
Mailing Address *
Your answer
Email Address *
Your answer
If we are unable to reach you, please contact:
Emergency Contact Name *
Your answer
Emergency Contact Relationship to Participant *
Your answer
Emergency Contact Home Phone Number (XXX-XXX-XXXX) *
Your answer
Emergency Contact Cell Phone Number (XXX-XXX-XXXX) *
Your answer
Emergency Contact Email Address *
Your answer
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