Koinonia Farms Camp 2025 November Student Retreat

April 2026 Student Retreat

Friday, April 10th 6:30PM - Sunday, April 12th 8:00AM. Fill out the form carefully for registration. Please contact us with any questions or concerns.
Name of person filling out form.*

First NameLast Name
Relation to student*
Student name*

First NameLast Name
Student Birth Date*

MonthDayYear
Student Gender*
Address of student*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail*
example@example.com
Parent/Guardian Mobile Number*
Format: (000) 000-0000.
Emergency contact Phone Number*
Format: (000) 000-0000.
Does the student attend a church or religious institution?*
If student attends a church, which one?
Please list any sport or extracurricular activities in which the student participates.*
Student's current grade level*
Does the student have any allergies, medical needs or dietary restrictions?*
If yes, please provide any information that pertains to the student's need.
Additional Comments
Should be Empty:

April 2026 Student Retreat