2026 YG Winter Retreat

Early Bird

$195.00

Prices are in USD.

Who’s this registration for?

First name

Last name

Email address

Contact phone

Anything else you’d like to tell us?

e.g. dietary (gluten intolerant, vegetarian, etc) or other requirements

Additional Student Information

Birthday

Grade

Sweatshirt Size (adult sizes)

Are there any allergies and/or medication that your child is bringing to the retreat? Does your child need medication to be administered by retreat staff members?

Do you agree that if your child brings a phone, he or she must turn it in at the beginning of the retreat to his or her counselor? (It will be returned at the end of the retreat.)

Yes No

Rooming request (Note: It is not guaranteed that all rooming requests can be accommodated, thank you for understanding.)

Emergency Contact

Parent Name

Phone Number

Second Emergency Contact

Phone Number

Relationship to student

Release Form

I hereby release and waive any and all claims that I may have against New Mercy Community Church, and any of their affiliates, agents, servants, employees, officers, directors and volunteers. I hold free and harmless, assume liability for, and defend New Mercy Community Church and their affiliates, agents, servants, employees, officers, volunteers, and directors from any and all costs and expenses, including but not limited to, attorney's fees, reasonable investigative and discovery costs, court costs, and all other sums that the New Mercy's chartered organizations, and any of their affiliates, agents, servants, employees, officers, volunteers, and directors incur as a result of any demand for claim or assertion of liability under any municipal, state or federal law or cause of action, including any action under the Americans with Disabilities Act, arising or alleged to have arisen out of any act or omission of, or any use of real or personal property belonging to New Mercy, and chartered organizations, and any of their affiliates, agents, servants, employees, officers, volunteer’s, and directors.

I agree

Yes

Parent's Name

Today's Date

Booking details

Who’s this registration for?

Additional Student Information

Emergency Contact

Release Form

Contact the event organizer