IMPACT 2021 Winter Retreat Registration

DETAILS: Our IMPACT Winter Retreat is happening Saturday, January 2 - Monday, January 4 at Carolina Creek Christian Camp in Huntsville, TX. Departure and return times will be announced closer to the actual retreat date.

COST: The cost of the retreat is $120, which can be paid online at parkgate.church/giving or via cash/check at the church. If paying at the church, please ensure you've included information on who the payment is for and that it goes towards Winter Retreat. You should also plan to send cash with your child for a fast food dinner on Friday night.

MEDICAL RELEASE: In addition to submititng this form, please ensure you've completed the 2021 edition of our Parkgate Student Medical Release Form for each student attending the retreat.

Family Last Name: *

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Phone Number *

Area Code Phone Number

Email *

example@example.com

How many students are you registering? *

Student 1 Name: *

First Name Last Name

Student 1 Grade: *

Student 2 Name:

First Name Last Name

Student 2 Grade:

Student 3 Name:

First Name Last Name

Student 3 Grade:

I plan to pay: *

Online Via Cash Via Check