Fall Retreat 2026

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"RENEW"

Fall Retreat 2026 at Hillcrest

*Event Ages: 6th-12th Grade

*Event Address: 2000 Muldoon Rd. Anchorage, AK 99504 (Hillcrest Church of the Nazarene)

*Event Check In: Doors open for check in at 7pm Friday October 9th, 2026

*Event Ends: at 11:30am on Sunday, October 11th. Families are invited to attend the final service with their students at 10:15am on the 11th!

Here are a few items that your student should bring:

Bible, journal, and pen (cell phones are permitted for Youversion Bible App, but a paper Bible is great for quiet time/devotions)
Jacket and appropriate cold weather attire for the bonfire night.
Pillow, bed roll and/or an air mattress, blankets
Appropriate sleeping attire
Personal hygiene products, change of clothes for Saturday and Sunday

*Any student that transports themselves will be required to turn their keys in upon check-in.

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Student Information

A single form should be filled out for each student!

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Student's Name* This field is required.

First Name

Last Name

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Birth Date* This field is required.

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Grade* This field is required.

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Gender* This field is required.

Male

Female

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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T-shirt Size* This field is required.

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Church Association

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Parent/Guardian Information

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Parent/Guardian Name* This field is required.

First Name

Last Name

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Cell Phone Number* This field is required.

Please enter a valid phone number.

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Work Phone Number

Please enter a valid phone number.

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Email* This field is required.

example@example.com

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Emergency Information

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Emergency Contact Name* This field is required.

First Name

Last Name

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Relationship to Student* This field is required.

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Emergency Contact Number* This field is required.

Please enter a valid phone number.

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Alternate Phone Number* This field is required.

Please enter a valid phone number.

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Select One:* This field is required.

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If you selected that your student has special needs or considerations please elaborate: (ex. medications, allergies, dietary restrictions, etc.) Medications will need to be turned in to the designated leader upon check in.* This field is required.Type N/A if you selected no

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Is the student prescribed an inhaler? If yes, please explain any instructions.* This field is required.If no, type N/A

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Medicine prn(as needed)* This field is required.Please check if a designated leader is allowed to give to your student.

Ibuprofen

Acetaminophen

None of the above

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Media Release: I give Alaska District NYI permission to use any photo, audio, or video footage depicting my student(s) taken during this event for promotional purposes.* This field is required.

YESNO

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Medical Release and Authorization

In the event of a medical emergency, if I cannot be contacted, I hereby give permission to the church staff, chaperones, trip leaders, and authorized drivers in cooperation with Alaska District NYI and Hillcrest Church of the Nazarene to provide necessary medical treatment for my child. In the event of an emergency I hereby give permission to medical personnel to administer necessary medical treatment including hospitalization for my child. I will be responsible for the expense of any such emergency medical procedures or treatment.

I hereby release and waive all claims against Hillcrest Church of the Nazarene, Alaska District Church of the Nazarene, their employees, representatives, volunteers, drivers, and chaperones related to this event.

This form has been signed only after understanding and considering all of the information set forth above.

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Informed Consent and Acknowledgement

In the signing of this document, I state that I am the parent/legal guardian of this student and I hereby authorize and give my permission for my student to participate in Fall Retreat 2026. I understand that volunteer staff, chaperones, and trip leaders will supervise my child at this event.

In addition to this, all students are expected to respect each other and all adult leaders and abide by any rules set forth at this event. Failure to do so may result in removal from the event. There will be no refunds for this event once the payment has been made. All payments are due by check-in.

All students are expected to remain at the event the entire time and will be required to turn in their keys if they drive themselves. Any arrangements in which a student needs to leave, show up late or get picked up early must be communicated at least a week prior to the event. If there are any time restraints or conflicts that will coincide with this event please state the details in the special considerations portion of this form.

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Signature* This field is required.BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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Name* This field is required.

First Name

Last Name

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Date* This field is required.

Date

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Payment Information

*There is a link on the confirmation page to pay online! You can also pay by check! Please make checks payable to Hillcrest Church of the Nazarene. Please ensure that all payments are designated to Fall Retreat with your student(s) name.

*Early Bird registration is $65; After September 18th registration is $85. Final day to register is October 9th! All payments are due upon check-in on October 9th.

*If you have questions, contact Andrew Sheets at pastorandrew@hillcrestnaz.com or (402) 710-1608!

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How will you be paying?* This field is required.

Online

Check

Cash

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Additional Comments