Confirmation Retreat Registration

The Confirmation Retreat is for youth in grades 6-8. Youth must be a part of a group with a chaperone. Cost is $60 per youth and $30 per chaperone.

Group Leader Name*

Who is the point person for organizing your church's youth for this event?

First Last

Group Leader Email*

Group Leader Phone*

Church*

Which church are the youth from?

Youth

How many youth are you registering?

Youth Name #1*

First Last

Youth #1 Gender*

Male
Female

Youth #2 Name*

First Last

Youth #2 Gender*

Male
Female

Youth #3 Name

First Last

Youth #3 Gender*

Male
Female

Youth #4 Name

First Last

Youth #4 Gender*

Male
Female

Youth #5 Name*

First Last

Youth #5 Gender*

Male
Female

Youth #6 Name*

First Last

Youth #6 Gender*

Male
Female

Youth #7 Name*

First Last

Youth #7 Gender*

Male
Female

Youth #8 Name*

First Last

Youth #8 Gender*

Male
Female

Youth #9 Name*

First Last

Youth #9 Gender*

Male
Female

Youth #10 Name*

First Last

Youth #10 Gender*

Male
Female

Youth #11 Name*

First Last

Youth #11 Gender*

Male
Female

Youth #12 Name*

First Last

Youth #12 Gender*

Male
Female

Youth #13 Name*

First Last

Youth #13 Gender*

Male
Female

Youth #14 Name*

First Last

Youth #14 Gender*

Male
Female

Youth #15 Name*

First Last

Youth #15 Gender*

Male
Female

Chaperones

Youth must be a part of a group with a chaperone. Chaperone registrations are about 1/2 price of youth. If youth are being chaperoned by another group, please enter that church's name in the Church field at the top of the page. We recommend 1 chaperone per 8 youth per gender. All chaperones must have a completed background check within the last 12 months with their congregation. No chaperones with violent felonies or sexual offenses are allowed.

Chaperone #1 Name*

First Last

Background Check*

This chaperone has a current and valid background check on file at our congregation.
This chaperone will have a current and valid background check completed before the retreat.

Chaperone #1 Gender*

Male
Female

Chaperone Name #2*

First Last

Background Check*

This chaperone has a current and valid background check on file at our congregation.
This chaperone will have a current and valid background check completed before the retreat.

Chaperone #2 Gender*

Male
Female

Chaperone Name #3*

First Last

Background Check*

This chaperone has a current and valid background check on file at our congregation.
This chaperone will have a current and valid background check completed before the retreat.

Chaperone #3 Gender*

Male
Female

Chaperone Name #4*

First Last

Background Check*

This chaperone has a current and valid background check on file at our congregation.
This chaperone will have a current and valid background check completed before the retreat.

Chaperone #4 Gender*

Male
Female

Chaperone Name #5*

First Last

Background Check*

This chaperone has a current and valid background check on file at our congregation.
This chaperone will have a current and valid background check completed before the retreat.

Chaperone #5 Gender*

Male
Female

Dietary Restrictions

Do you or does anyone in your group have any dietary restrictions? If so, please inform us so that we can accommodate your food needs. Otherwise, please leave blank.

Total

$0.00

Payment Type

Pay online or by check.

Pay Online
Mail Check to Iowa District East
Bring a Check to the Retreat

Credit Card

Confirmation Retreat Registration

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