SnoGlo 2027

REGISTRATION

High School & Middle School Winter Retreat
Jan 29-31, 2027
$150/person
(50% discount for siblings!*)
*All children must be registered at once to receive this discount. Price for each additional child in a family with multiple children is $75.

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

Registration Deadline November 11, 2026.

QUESTIONS? For questions about registration or emergencies/concerns during the retreat, please contact:
Pastor Josh Von Holt, Youth Pastor (cell: 845-729-4001)
Heather Hunsberger, Youth Assistant (church: 610-868-5501)

Number of Students You are Registering

Student #1

Name - Student #1

First NameLast Name

Age - Student #1

At SnoGlo

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

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

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

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 $

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.