WHEREHOUSE Middle School Student Retreat

When: November 12-14, 2010

Students will have a fun and growth time in worship, Bible studies and recreation at this Fall Retreat to be held at South Mountain Christian Camp in Bostic, NC.

Please complete both the Parent fields and Student (child) fields below and submit with the full cost amount of $75, or a deposit of $20 to reserve your spot!

* marks required fields
 
*Your Name:
*Your E-mail Address:
Phone Number: 
   
   
Child Information
Name:
Gender:
Date of Birth:
Special Health / Allergy / Other Concerns:
Emergency Contact Name:
Emergency Contact Number:
Emergency Contact Relation:
T-Shirt Size:
Youth Medium
:
Youth Large
:
Adult Small
:
Adult Medium
:
Adult Large
:
Adult X-Large
:
Adult 2XL
 
  Quantity
Student Total : $75.00
   
   
 
  Quantity
Student Deposit : $20.00
   
   
 

 

Bethlehem Church Office
3100 Bethlehem Church Street, Gastonia, NC 28056
P. O. Box 551387, Gastonia, NC 28055-1387
704.823.1600 (phone), 704.823.1278 (fax)