Jr. High Spring Retreat Online Registration
Click here for a flyer

We accept

   

Please Note:
You will be transferred to a secure server
prior to entering your credit card information.

Registration Information:  
First Name:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
School:
Grade:
Small Group Leader:

Medical/Liability Release
 I do have a release form on file.
I do not have a release form on file (please download a release form here, fill out and turn in to the Immanuel Student Ministries office)
 

By checking this box and typing my name in the box below, I give permission for my son/daughter to attend this event and verify that I have filled out a medical release form.

Parent/Guardian Signature
Email Address
   After all information has been entered, please click the Continue button.