2024-2025 ALL CHURCH RETREAT REGISTRATION

Name

Spouse's Name

Address

Phone

This address will receive a confirmation email

Child #1

Child #1 Name

Date of Birth:

Age

School Grade (Fall)

Child #2

Child #2 Name

Date of Birth

Age

School Grade (Fall)

Child #3

Child #3 Name

Date of Birth:

Age

School Grade (Fall):

Child #4

Child #4 Name

Date of Birth

Age

School Grade (Fall):

Release Waiver

I do hereby authorize Jubilee Bible Church to act on my behalf in the event of an emergency during the period of October 4 – 6th, 2024. This authorization is given for the express purpose of ensuring the safety, health, and well-being of me & my child(ren) during the given time period, and includes, but is not limited to, emergency medical attention. I waive any claims of liability against Jubilee Bible Church, the staff and volunteers of Jubilee Bible Church, or any other parties associated with Jubilee Bible Church for any harm incurred in furtherance of the purpose of this authorization.

Release Waiver Signature (covers all adults and children on this registration)

authorize JBC to act on my behalf do not authorize JBC to act on my behalf

Date Release Was authorized

Please List Any Allergies, Medication or Medical Conditions that you and/or your child(ren) currently have that we need to be aware of. If none, type NONE.

Any special requests regarding your registration--late arrival, early departure, special diet requests or lodging requests, or do you need to carpool with someone?

Cost: Cost: Early Bird Pricing thru August 31st.

$180 per Adult (including youth and college)*
$90 per Child (ages 4-11)*
Free – Infants & Toddlers (up to age 3)*

After August 31st.
$200 per Adult (including youth and college)*
$100 per Child (ages 4-11)*
Free – Infants & Toddlers (up to age 3)*

*Maximum family registration is $700; cash or check made payable to Jubilee Bible Church. Need-based financial support is available! Please speak to Pastor Michael ASAP!

Will need transportation to/from retreat.

yes no

If you aren't planning to pay online, please leave the amount field blank or zero, otherwise it will request your credit card information.

Payment

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

October 4th-October 6th, 2024

Dates: Friday evening, October 4th – Sunday afternoon, October 6th, 2024 [hotel-style lodging + 5 meals]

Location: Cedar Lake Ministries [13701 Lauerman Street, Cedar Lake, IN 46303] – cedarlakeministries.org
Theme: "Rooted and Built Up" - Colossians 2:6-7
Speaker(s): Adult Worship: Brad Sturm
Children Worship: Alisha Henricksen

Cost: Early Bird Pricing thru August 31st.
$180 per Adult (including youth, high school & college)*
$90 per Child (ages 4-11)*
Free – Infants & Toddlers (up to age 3)*

After August 31st.
$200 per Adult (including youth, high school & college)*
$100 per Child (ages 4-11)*
Free – Infants & Toddlers (up to age 3)*

*Maximum family registration is $700; cash or check made payable to Jubilee Bible Church
Need-based financial support is available! Please speak to Pastor Michael ASAP!

2024-2025 ALL CHURCH RETREAT REGISTRATION

Description

Please Fix the Following