Young Christian Leaders Retreat Registration Form

Please complete the registration form below to confirm your attendance.

* = required field

Student Name *

First

Last

Student Gender *

Student Date of Birth *

YYYY

Student Email Address *

Student Phone Number *

###

####

Where do you attend high school? *

Graduation Year *

Senior (Class of 2024)

Junior (Class of 2025)

Sophomore (Class of 2026)

What church do you attend? *

T-shirt size? *

Parent Name *

First

Last

Parent Email Address *

Parent Phone Number *

###

####

By checking this box, I confirm that I will attend the 2024 Young Christian Leaders Retreat *

Yes

By checking this box, I confirm that I have thoroughly read the release form and will attach it to this web submission *

Yes

Attached Student Release Form here *

Spam Prevention *

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Malone University - Christ's Kingdom First