Collin Fall Retreat 2024 -

Name*

First Last

Email*

Phone*

Gender*

Female
Male

Will you be at least 18 years old on Oct 19?*

Yes
No: YOU WILL NEED TO GET A MINOR RELEASE FORM FROM A STAFF MEMBER

Are you a part of a Core group? If so, which one?*

I am not part of a core
Stian & Kevin
Dak & Joel
Mick & Gio
Adriana & Audrey
Mackenzie & Adriana
Tania & Jacy
Pedro & Mackenzie

Emergency Contact*

First Last

Emergency Contact Phone*

Please list any medications or conditions we should be aware of in case of an emergency

Please list any dietary restrictions here

Will you need financial assistance to be able to attend fall retreat?*

Yes
No

Will you be staying overnight?*

Yes
No

Would you like to pay for Collin Fall Retreat online now?*

Yes, I'll pay $40.00 now for Collin Fall Retreat.
No, I'll pay later for Collin Fall Retreat.

Would you like to pay for Collin Fall Retreat online now?*

Yes, I'll pay $15.00 now for Collin Fall Retreat.
No, I'll pay later for Collin Fall Retreat.

If you would like to include a scholarship to help other students pay for Collin Fall Retreat, you can enter the amount here. *Once everyone is paid for, any leftover funds will be transferred to the general fund to further the mission of FOCUS.

Total

$0.00

Credit Card

Card Details

Cardholder Name