Search Retreat 2022
April 22nd, 23rd and 24th.
Mount Gilead Retreat Center
Mount Gilead Retreat Center, Stroudsburg, PA
Name
First Name
Last Name
Name Preferred on Name Tag
(If Different From Above)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
Male, Female, Non-Binary, Etc.
Age
Email
example@example.com
Parent / Guardian Email
example@example.com
Parent/ Guardian Phone Number
-
Area Code
Phone Number
Candidate Phone Number
-
Area Code
Phone Number
Name Of Current Church, If any.
Church Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Denomination of Church
Pastors Name
Name Of Current School
Grade
Are you active in any religious, school or community organization?
Yes
No
If Yes, Please List
Do you have any MEDICAL ISSUES, or on and MEDICATION or on a SPECIAL DIET?
Yes
No
If Yes, Please List
If Yes, Please list doctor's name and phone number.
Doctor
Phone Number
Shirt Size
*
Small
Medium
Large
X-Large
Other
If 'Other' was selected, what size?
Parents
Mother
First Name
Last Name
Father
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
-
Area Code
Phone Number
In case of an Emergency, please provide a phone number and the name of a parent or guardian who can be reached during the weekend.
Name
Number
Relationship to Applicant
Does Search have permission to display Retreat Photos of your child on our web site?
Yes
No
How did you hear about Search?
Please Read Carefully Before Signing
Be Sure to read the accompanying letter that describes briefly what the weekend is about. THIS IS A NON-SMOKING AND DRUG FREE WEEKEND. Any drugs found will be confiscated and the applicant may be sent home. This weekend has been planned in order to assist in the Christian growth of teenagers and adults. It is designed to be informative, spirit filled and fun once the rules stipulated above are followed. By signing below you indicate that you have read and understood the above rules and the letter describing briefly what the weekend is about.
Applicant
Clear
Parent Or Guardian
Clear
Payment:
Payments can no longer be made online. You now have two options to pay for the weekend. You may Bring cash or check to the weekend retreat. option 2: Please send a check for $130 made payable to 'Michelle Radford' with 'Search' in the memo. You may also choose to print the application and send payment in to the address listed below Please Send Printed Application and Check to: Michelle Radford 626 Lathrop Ave. Boonton Township, NJ 07005
For more information please contact:
Tim Booth (Director) (717) 654 - 7556 Michelle Radford (Retreat Coordinator) (973) 634 - 5904
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