2026 Message Retreat Registration Form

Emergency Contact Information
Emergency Contact

First NameLast Name
Emergency Contact Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Email:
example@example.com
Emergency Contact Relationship:
Ex. Father, Mother, Grandmother, etc.

Health Insurance Information
Do you have health insurance?
Name of Health Provider
Provider Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Member ID
Group Number
Do you have any food allergies or prescribed medication that we should be aware of?
If Yes, please specify all food allergies and/or prescribed medication taken.

Agreement & Signature
Please read through "The Message Retreat Covenant Consent Form 2026" which includes the:

1. Press & Medical Release

2. Code of Conduct

The Message Retreat Covenant Consent Form 2026

All registrants and parent (if applicable) must agree to the covenant consent form to attend this retreat.
Does you registrant and parent (if under the age of 18) acknowledge that I have read and agree to the Message Retreat Press and Medical Release on this form? I have also read and agree to abide by the Message Retreat Code of Conduct & Electronics Agreement.
Registrant Name

First NameLast Name
Signature
Name of Parent/Guardian

First NameLast Name
Parent/Guardian Signature
Should be Empty:

Registrant Information