YES Youth Registration Form

YES Youth Registration Form

The Kairos YES Retreat
Part 1 of 4: YES Retreat Information
Name of Event

2026 YES Retreat

Sponsoring Organization

Kairos North America (a DBA of the Sword of the Spirit)

Date

Friday, March 27 - Sunday, March 29, 2026

Cost

In-Person Attendees- $220 per youth due by March 15

Registration will close after March 22

Cost will increase $50 on March 15

Location

Michindoh Conference Center, 4545 E. Bacon Rd. Hillsdale, MI 49242

Michindoh’s Phone Number

517-523-3616

Arrival/Departure Info

Check-in opens at 5:00 pm on Friday
Dinner is available from 5:30-7:00pm. The first session begins at 7:30pm.
The retreat ends at 1:00 pm on Sunday

Supervising Adults

Stephen Giles, Molly Kilpatrick

Emergency phone number

Stephen Giles: 517-402-3631

What to bring
- Bible
- Notebook and pen
- Bedding (pillow, sleeping bag or sheets)
- A towel and toiletries
- Warm clothing
- Recreation clothing
- Something nicer to wear for the Lord's Day
Transportation

Please arrange your own or contact your Youth Group Leader
Part 2 of 4: Youth and Guardian Information

Youth's Information
Youth Name*

Youth First NameYouth Last Name
Youth Email*
example@example.com
Youth Sex*

FemaleMale
Community Location*

Ann Arbor - Word of LifeColumbus - CornerstoneDallas - Families For ChristGrand Rapids - Light of ChristKansas City - Heart of the RedeemerLansing - Work of ChristLivonia - Christ's Ardent Disciples in ActionLos Angeles - City on the HillMaryland - Triumph of the CrossMiami - Comunidad La Nueva JelusalénMinnesota - Community of Christ the RedeemerNew Jersey - Family of FaithNew Jersey - People of HopePhoenix - City of the LordPittsburgh - People of GodSeattle - Beacon of JoyTallahassee - Fountain of LifeToronto - Jesus the Good ShepherdToronto - One With God CommunityVancouver - Families for Christ CommunityOther
City and/or community that you're coming from*
Name of person inviting you (if coming as guest)*
Year in High School*
Youth Birth Date*

MonthDayYear
Date
Tradition or Church Background*

AnglicanBaptistCatholicLutheranNon-DenominationalOrthodoxPresbyterianReformedOther
T-Shirt Size - cost for a t-shirt is included in the retreat fee*

SmallMediumLargeExtra-Large
Guardian's Information
Registering Parent's Name*

Parent First NameParent Last Name
Registering Parent's Email*

Confirmation EmailConfirm Registering Parent's Email address
Registering Parent's Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState/Prov. Code

Zip Code
Emergency Contact
Emergency Contact's Name*

Emergency First NameEmergency Last Name
Emergency Contact’s Relationship to Participant*
Emergency Contact's Phone*
Please enter a valid phone number.
Part 3 of 4: Medical Information
Family Health Insurance Provider*
Health Insurance Card Holder's Name*
Health Insurance Policy Number*
Doctor's Name*
Doctor's Phone Number*
Does your child have any dietary allergies or concerns?*

NoYes
Dietary allergies or concerns explanation*
Please explain the dietary allergies or concerns your child has. Kindly also inform us of their severity i.e. type of reaction (rash, hives, difficulty breathing, vomiting). There is a refrigerator available for those needing to bring special foods; the kitchen can also make some accommodations if notified in advance. Do let us know if your child plans to bring their own food, or if you would like us to speak with the kitchen and determine if we can accommodate your child’s needs.
Is your child currently taking any medications?*

NoYes
Current Medications List:*
Please list and explain the medications your child takes, including the medication name, amount, and regimen.
Is your child allergic to any type of medications?*

NoYes
Medication allergies explanations:*
Please list the medication(s) to avoid. This information will be useful to provide if your child requires medical attention.
Medical Conditions: Has your child experienced any of the following:

Asthma/Wheezing/Hay FeverStomach/bowel problemsDiabetes/HypoglycemiaConvulsions/Seizures/EpilepsyFainting spellsThyroid problemsHeart problemsMobility Concerns
Medical Conditions explanation:*
If any above medical conditions are checked, please explain. For example: If your child has asthma, is it exercise induced? What triggers an attack? Is it controlled with medication? What medication, dose and frequencies? Has your child ever been hospitalized for an asthma attack? If yes, how frequently and when was the last admission?
Personal Considerations:
Kairos staff are trained in Christian youth work, and we will have a nurse on site to provide basic first aid, but some emotional or behavioral issues may require special awareness from the staff. These details will be shared with only the appropriate adults (cabin leader, small group leader) to properly supervise your child during the YES retreat.
Does your child exhibit (now or within the past two years) any of the following?

Sleep-WalkingBed-WettingHome-SicknessSelf-Harm (thoughts or actions)Eating DisorderViolent BehaviorProblems Dealing with EmotionsDisciplinary Problems at Home or at SchoolCare from a Psychiatrist/Therapist/Counselor
Personal Considerations explanation:*
If any above personal consideration items are checked, please explain. These details will be shared with only the appropriate adults (cabin leader, small group leader) to properly supervise your child during the YES retreat.
Other Medical: Is your child being treated for any other injury or sickness that you haven’t already indicated above?*

NoYes
Other Medical explanation:*
Please describe any other medical condition that would be helpful for our staff or medical personnel to know. If there is a need to take your child to the hospital the information on this form will be used to assist in giving him/her the best possible care.
Part 4 of 4: Parental Consent and Payment
Signature of Parent/Guardian*

Clear
Use your mouse or finger to draw your signature above
Printed Name Parent/Guardian*

First NameLast Name
Today's Date*

MonthDayYear
Cost*
Payment Preference*

Pay by credit cardPay by checkMy youth group is handling my payment
Check should be written out to:
The Sword of the Spirit

In the memo line write:
"Yes retreat" along with the names of the people you're paying for.

Mail to:
Attn: Yes Retreat
Kairos
1502 River Terrace
East Lansing, MI 48823

Please note: If you pay after March 15, you will owe an additional $50.00 as a late fee. If your payment is not received by March 22, we will cancel your registration.
A payment page will be shown after you hit "Submit" below. An invoice will also be sent to your email address (so you could pay later). This amount will be shown on the invoice:

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YES Youth Registration Form

Part 1 of 4: YES Retreat Information

Part 2 of 4: Youth and Guardian Information

Part 3 of 4: Medical Information

Part 4 of 4: Parental Consent and Payment