2025 GKD Retreat Registration

April 25-27 | The cost of the 2025 GKD Retreat is $130/child
* $50 Deposit due when registering.
* $80 Balance due by day of departure.

Child Name

*

Child Grade

*

Please select one option.

1st 2nd 3rd 4th 5th Leader

Shirt Size (sizes are limited. First come, first served)

*

Please select all that apply.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Parent Name

*

Phone

*

Email

*

This address will receive a confirmation email

Child's Allergies or Other Medical Information

*

Emergency Contact & Phone Number

*

Insurance Company & Policy Number (copy of insurance card is required for your child to attend)

*

Transportation & Housing Permission

I give Grace Assembly of God permission to transport and house my child with other children and adult volunteers from our church for the weekend of April 25-27, 2025.

*

Please select all that apply.

Yes

Payment $130/child) Deposit is $50, Balance due the day we leave

Pay Deposit ($50) Pay full amount ($130) I will pay this amount now:

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

April 25-27

The cost of the 2025 GKD Retreat is $130/child
* $50 Deposit due when registering.
* $80 Balance due by day of departure.

Please Fix the Following

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