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Register by Sunday, October 28th

$75 per student    $125 family max. 

Price will increase by $10 per month after due date

ROCK Retreat Registration:

Student Name *
Student Name
Please select:
Student Cell Phone *
Student Cell Phone
Student Birthdate *
Student Birthdate
Address *
Address
Parent/ Guardian Name *
Parent/ Guardian Name
Parent / Guardian Phone *
Parent / Guardian Phone
Photo Release *
Please select an option below:
Permission *
Please select below: