Beach Retreat Registration
July 17-19, Lakeside UMC
CHILD INFORMATION:
Child Name
*
First Name
Last Name
Additional Child Name
First Name
Last Name
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name
*
First Name
Last Name
I am interested in attending Beach Retreat as a chaperone.
Yes
No
Maybe
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
MEDICAL INFORMATION
Medical Concerns (please put N/A if none)
Does your child have any dietary restrictions we should know about?
Please select dinner options your child would prefer (select all your child you eat)
Taco Bar (ground beef, taco fixings, rice, etc.)
Hamburgers/Hotdogs
Baked Potato Bar (shredded chicken, fixings)
Italian (Chicken Fettucine or Lasagna, salad, bread)
Submit Form
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