Rugged Retreat 2021 --- Event Scheduled for April 8-11

Please fill out this form and click submit to register your student for the Rugged Retreat. Your registration and and fee is due by March 31st to reserve their spot.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

How Many Students are Registering?

*

Please select one option.

1 2 3 4 5 6 7

Please let us know of all allergy or medical concerns for your student(s).

*

1st Student

*

2nd Student

3rd Student

4th Student

5th Student

6th Student

7th Student

Payment

Online Payment 1 Student ($53.00) Online Payment 2 Students ($103.00) Online Payment 3 Student3 ($154.50) Online Payment 4 Students ($206.00) Online Payment 5 Students ($257.50) Online Payment 6 Students ($309.00) Online Payment 7 Students ($360.50) Pay at Church 1 Student ($50) (0) Pay at Church 2 Students ($100) (0) Pay at Church 3 Students ($150) (0) Pay at Church 4 Students ($200) (0) Pay at Church 5 Students ($250) (0) Pay at Church 6 Students ($300) (0) Pay at Church 7 Students ($350) (0) Use Students4U Account (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit to register your student for the Rugged Retreat. Your registration and and fee is due by March 31st to reserve their spot.

Please Fix the Following

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