HCCYG Winter Retreat with Michigan Conference
at Ada Congregational Church January 30-31, 2027
Participant Name
First Name
Last Name
Participant Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
2026-2027 Grade
Phone Number for communication about retreat
Please enter a valid phone number.
Format: (000) 000-0000.
Food allergies or dietary accommodations needed
Medical needs or severe allergies
any other accommodations that would make participation in retreat easier
Emergency Contact Name weekend of January 30-31st
First Name
Last Name
Emergency Contact phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact relationship to participant
Submit
Should be Empty: