Van Isle Youth Retreat
Lighthouse Youth
Name
First Name
Last Name
Age
Sex
Emergency Contact
Please enter a valid phone number.
BC Services Number
Dietary Restrictions
Medical Information
Payment ($75)
Etransfer to give@vilifechurch.com (in the message box put youth retreat)
Cash
Today's Date
-
Month
-
Day
Year
Date
Guardian Signature
Submit
Should be Empty: