Personal Info


First Name
Last Name
Marital Status
Spouse
Spouse's First Name
Spouse's Last Name
Spouse's E-mail
(please use your primary e-mail address to receive all Young Adult Retreat info)
Confirm Spouse's E-mail
* Birthdate (mm/dd/yyyy)
We would prefer to room with single young adults from our Corps.
Address
City
State
Zip Code
Phone
Division
Corps
E-mail address
(please use your primary e-mail address to receive all Young Adult Retreat info)
Confirm E-mail address
* Birthdate (mm/dd/yyyy)
Gender
Dietary Restrictions
Emergency Contact
Name
Phone

Workshops


Registration Fees


Registration and meals
$0
# of Children (Only children age 0-5 allowed):  
($10.00 per child)

$0
#1 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#2 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#3 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#4 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#5 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#6 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#7 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#8 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#9 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
#10 First Name:
Last Name:
DOB: (mm/dd/yyyy)

Other:
Total amount due$0

Agreements


You must check all of the following boxes to indicate your agreement with these statements before submitting your registration.

By checking this box I personally assume responsibility for my actions, and release The Salvation Army from loss, injury or damage to myself or my property provided that nothing contained herein shall excuse The Salvation Army from responsibility to act with reasonable care for the health and safety of myself or my property.
By checking this box I hereby give The Salvation Army permission to use photos of me involved in Young Adult Retreat activities in their publications, promotions or other ministry materials.
If you choose not to check this box please call on to register.
By checking this box I hereby give permission to the medical personnel selected by the conference director to order x-rays, routine tests, treatment; to release any records necessary for insurance purposes, and to provide or arrange necessary related transportation for me. Should any dispute or controversy arise, I agree to seek resolution according to Biblical principles.

Completing your registration



Check that all of the information entered above is correct and then click the "Submit Registration" button below to process your registration.




*You must be between the ages of 18-29 (by 10/27/2017) OR active in young adult ministry on the local Corps or Divisional level to attend.