CP Retreat 2022

2022 Church Planter Retreat Registration

Name*

First Name

Last Name

Church Name

Church Location - city/state

Email*

Best phone # to reach you during the event*

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

My spouse will be attending with me*

Yes No

Spouse Name*

Spouse Cell Phone*

Spouse Email Address*

My children will be attending with me*

Yes No

Children's Registration

We are providing Kids Club for babies through 5th grade.

The Kids Club theme this year is LifeWay's VBS Spark Studios!

Teens, grades 6-12, come to Teen Club, or volunteer to assist in Kids Club.

Make a note about preference in the Comments section.

How Many Children Will Attend with you?

Additional authorized pick-up person #1, if any (besides Mom/Dad) - First & Last Name & Cell

Additional authorized pick-up person #2, if any (besides Mom/Dad) - First & Last Name & Cell

Comments (If registering any 6-12th graders, note here if they will do teen club or would like to volunteer with the younger kids).

May we have permission to use your children's photograph(s) in church publications?*

Yes No

Child 1

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 2

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 3

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 4

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 5

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 6

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 7

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Child 8

Name*

First Name

Last Name

Preferred Name (for name tag)

Gender*

Birthdate*

Current grade in school*

Any allergies, medical &/or special needs?

Special meals needed?*

No Yes

*Special meal needed for MEDICAL reasons, not just personal preference.

Who in your family needs special meals?*

NOTE: You will also need to complete the online form with the conference center. The link will be included on the registration confirmation page.

Comments