Youth Spring Retreat 2026

REGISTRATION

Youth Spring Retreat
April 17-19, 2026
Registration Deadline April 1, 2026

$175/student
(50% discount for each additional sibling*)
*All children must be registered at once to receive this discount.

This form must be filled out & submitted by the student's parent or legal guardian.

Number of Students You are Registering

Student #1

Name - Student #1

First NameLast Name

Grade - Student #1

E-mail - Student #1

Cell Phone - Student #1

Format: (000) 000-0000.

Guest Of

Cost for Student #1

Student #2

Name - Student #2

First NameLast Name

Grade - Student #2

E-mail - Student #2

Cell Phone - Student #2

Format: (000) 000-0000.

Guest Of

Cost for Student #2

Student #3

Name - Student #3

First NameLast Name

Grade - Student #3

E-mail - Student #3

Cell Phone - Student #3

Format: (000) 000-0000.

Guest Of

Cost for Student #3

Student #4

Name - Student #4

First NameLast Name

Grade - Student #4

E-mail - Student #4

Cell Phone - Student #4

Format: (000) 000-0000.

Guest Of

Cost for Student #4

Parent/Guardian Information:

Name - Parent/Guardian

First NameLast Name

Email - Parent/Guardian

example@example.com

Phone Number #1 - Parent/Guardian

Format: (000) 000-0000.

Phone Number #2 - Parent/Guardian

Format: (000) 000-0000.

Medical Information:

Medical Insurance Company

Policy Number

Physician's Name

Physician's Phone Number

Format: (000) 000-0000.

Does your child have any health needs Ebenezer Bible Fellowship Church should be aware of?

If yes please explain. Please include names of medications/dosages that must be taken.

Does your child have any allergies (i.e. pollens/mold, medications, food, etc.)?

If yes, please describe allergy and treatment:

Does your child need a special diet?

If so, please explain their special diet:

Parental Agreements:

PHOTO RELEASE: I understand and will allow photos and videos of my child to be taken while attending Ebenezer Bible Fellowship Church events or activities and to be used in any Ebenezer Bible Fellowship Church publication.

Notes & Payment Information:

Any questions/comments for Pastor Josh?

Scholarship Request

Please explain reason needed and amount requested (half or full scholarship)

Total Due$

Payment Option

Online Payment Amt $

USDYouth Spring Retreat

Check Instructions:

Checks should be made payable to Ebenezer BFC, Memo: Youth Spring Retreat
Please hand in or mail to the church within a week after you register (3100 Hecktown Rd. Bethlehem PA 18020).