Youth Registration

Youth Registration 6th-10th Grade

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Please come join us for our Winter Junior High Retreat......

Theme: Myth Busters - Discovering the truth

To learn more about the speaker and the worship band, please the link below.

http://www.angelescrest.com/index.php?option=com_content&view=article&id=47&Itemid=64

Worship: High School Worship team
When: February 10-12 of 2012
Location: Angels Crest Christian Conference Center
Registration fee:$120.00

Name *

First

Last

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

Confirm Email *

Gender *

Male Female

Age *

Birth Month *

Birth Day *

Birth Year *

Grade finished *

T-Shirt Size *

Have you attended the Kids Retreats in the past? *

Yes No

Name of the church you currently attend *

Name of Parent or Legal Guardian *

Phone Number *

Emergency Contact Name *

Relationship *

Phone Number *

Email *

How did you hear about the retreat? *

Making a full payment? *

Yes No

Payment Options: *

Card Type: *

Name on the card: *

Card Number: *

Card expiration month: *

Card expiration year: *

cvv number on credit card: *

Billing Address (if different then above) *

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City

State

Zip Code

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Any Comments, concerns, prayer request or praise? *

Payment by mail

Please remit your payment to:
AEC
C/O 2010 Kids Retreat registration
P.O Box 660896
Arcadia, CA 91006

Welcome to the Amazing Bible Adventure

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Payment by mail