Hi-C March Retreat Registration - St Timothy Presbyterian Church -

If you are a human and are seeing this field, please leave it blank.

Fields marked with a * are required.

Name *

Birthday (mm/dd/year)

Grade

Student's Phone #

Student's Email

Emergency Parent Contact Name *

Parent Phone Number *

Parent Email Address *

Describe any allergies or health concerns that you have:

Describe any medication that you are on or will be taking at the retreat