Fall Retreat 2026 Registration

When: Oct 30th-Nov 1st

Departure 4pm on Oct 30

Where: Walnut Ridge (Morgantown, Indiana)

Who: 7th grade through 12th grade

Cost: $150*

All students will need to bring money for dinner on the way Friday - suggested $10-$15 each

*There will be a discount for families with more than one student attending this event after the first student. More than one student can be registered on this form.

Are you an adult leader/chaperone on this event?

How many students in your family are you registering for this event?

Student/Participant Name #1

First NameLast Name
I am
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please list any allergies:
Student/Participant Name #2

First NameLast Name
I am
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please list any allergies:
Student/Participant Name #3

First NameLast Name
I am
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please list any allergies:
Student/Participant Name #4

First NameLast Name
I am
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please list any allergies:

To grant permission, this form must be completed, signed, and dated by parent or guardian.
Student name #1
Student name #2
Student name #3
Student name #4
TRAVEL PERMISSION:

If transportation is provided, I give permission for my child/children to be transported by ECC Student Ministries.
Travel Permission:
Parent/Guardian Name:

First NameLast Name
Cell/Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature

Adult leader/chaperone name

First NameLast Name
Please list any food allergies
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Payment:

You may pay by cash, ECC Cash or check (made out to ECC Students), or online by credit/debit card.
I will be paying by:

Online payment (credit/debit)

Fall Retreat Registration 2026. 1 student

Fall Retreat Registration 2026

1 student

$150.00

Fall Retreat Registration 2026. 2 students

Fall Retreat Registration 2026

2 students

$275.00

Fall Retreat Registration 2026. 3 students

Fall Retreat Registration 2026

3 students

$400.00

Fall Retreat Registration 2026. 4 students

Fall Retreat Registration 2026

4 students

$500.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Email
example@example.com

Should be Empty: