SnoGlo 2027

REGISTRATION

High School & Middle School Winter Retreat
January 29-31, 2027
$150/person
(50% discount for siblings!*)
- DEADLINE: Registration Deadline is November 11, 2026.
- GUIDELINE: This form must be filled out & submitted by the student's parent or legal guardian.
- DISCOUNT: *All children must be registered at once to receive the sibling discount. Price for each additional child in a family with multiple children is $75.
- QUESTIONS: For questions about registration or emergencies/concerns during the retreat, please contact:
  Pastor Josh Von Holt, Youth Pastor (josh@aplaceforyou.org, 845-729-4001 (c))
  Heather Hunsberger, Youth Assistant (youth@aplaceforyou.org, 610-868-5501 (o))
Number of Students You are Registering
Student #1
Name - Student #1

First NameLast Name
Age - Student #1
At SnoGlo
Birthdate - Student #1

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade - Student #1
E-mail - Student #1
Cell Phone - Student #1
Format: (000) 000-0000.
Guest Of
T-Shirt Size - Student #1
Cost for Student #1
Student #2
Name - Student #2

First NameLast Name
Age - Student #2
At SnoGlo
Grade - Student #2
Birthdate - Student #2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
E-mail - Student #2
Cell Phone - Student #2
Format: (000) 000-0000.
Guest Of
T-Shirt Size - Student #2
Cost for Student #2
Student #3
Name - Student #3

First NameLast Name
Age - Student #3
At SnoGlo
Birthdate - Student #3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade - Student #3
E-mail - Student #3
Cell Phone - Student #3
Format: (000) 000-0000.
Guest Of
T-Shirt Size - Student #3
Cost for Student #3
Student #4
Name - Student #4

First NameLast Name
Age - Student #4
At SnoGlo
Birthdate - Student #4

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade - Student #4
E-mail - Student #4
Cell Phone - Student #4
Format: (000) 000-0000.
Guest Of
T-Shirt Size - Student #4
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$
$150/Person; $75/Siblings
Total Amt Due$
$150/Person; $75/Siblings
Payment Option
Online Payment Amt $

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USDSnoGlo
Check Instructions:
- Checks should be made payable to Ebenezer BFC, Memo: SnoGlo.
- Please put in the office drop box, or mail to the church: 3100 Hecktown Rd. Bethlehem PA 18020.
- Checks must be mailed the day this form is submitted, or dropped off at the church within a week.
Should be Empty:

Online Payment Amt $