Crossroads Fall Retreat 2022 - Student Registration

Please enter the student information for one child only.

In addition to this form - be sure you have also filled out the regular Crossroads registration: Regular Registration

Looking for more info? Click HERE to read our FAQ

Student Info

Name

Gender

Grade

6th 7th 8th 9th 10th 11th 12th Graduate

Student Phone

Address

Allergies

Dietary Restrictions

Current Medications

Health Insurance

Health Insurance Company

Policy Number

Name Of Insured

Parent Info

Parent Name

Parent Number

Parent Email

Emergency Contact Name

Emergency Contact Number

Student Read & Sign

Please click the following link to view the Crossroads Covenant.Ã‚Â After you are done reading, please type your name in the box below as a digital signature.

Crossroads Covenant

Students Digital Signature

Payment

* No refunds once forms / payments are submitted
* We cannot accept registration forms after Friday, November 4th
* Questions? Contact JC Fowler. 908-216-6643 or jcfowler@allentownpresbyterian.org

If cost is an issue, partial scholarships may be available. If you want to inquire about a scholarship, select "Scholarship" from the drop down menu and contact JC Fowler.

If you'd like to make a donation above and beyond the registration fee to help offset the cost of Shepherds and potential scholarships, select "Gift" and enter the amount.

Early Early Bird Registration - $155 by Friday, October 14th

Early Bird Registration - $170 by Friday, October 21st

Final Registration - $185 by Friday, November 4th

Never been to Crossroads?!? - $55 by Friday, November 4th

If you have never been to Crossroads and someone invited you on this retreat, tell us who it was here! (Please only put one person)

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

November 11 - 13, 2022

Crossroads Youth Ministry
Fall Retreat 2022

WHEN: November 11-13, 2022

WHERE: Sandy Hill Camp and Retreat Center - 3380 Turkey Point Road, North East, MD 21901

WHO: Middle school & high school students (6thâ€“12th grade)

DEPART: Friday, November 11th at 4:00 pm
*Middle school - parking lot across from Allentown Presbyterian Church
*High school - Crossroads Parking Lot
*Band - Crossroads Parking Lot at 3:30 pm.

PICKUP: Sunday, November 13th at 12:15 pm
Parents, join us for the close of the retreat at the 11:00 am APC service!
*Middle school - lower lot of Newell Elementary School
*High school - Crossroads Parking Lot

COST: (No Refunds)
Early Early Bird Registration - $155 by Friday, October 14th
Early Bird Registration - $170 by Friday, October 21st
Final Registration - $185 by Friday, November 4th

Questions?
Contact JC Fowler: 908-216-6643 or jcfowler@allentownpresbyterian.org

Crossroads Fall Retreat 2022 - Student Registration

Description

Please Fix the Following