ReThink College Camp Registration Form PLEASE NOTE: If you are registering multiple students you will need to complete separate Parent/Student Questionnaire forms for each. Questions must be answered by a parent or guardian for students under 18. This information will be kept confidential. I am a Parent (or Guardian.) YesNo I am a Student. YesNo Student is 18 years old or older (You can skip parent / guardian info): YesNo Student is 17 years old or younger (Please have your parent or guardian complete this form): YesNo We promise to inform ReThink315 if I am (or my student is) exposed to COVID-19 or if I (or my student) exhibit any COVID-19 symptoms within 10 days of this event: Yes Initial here: Parent/Guardian Information Parent or Guardian's First Name Parent or Guardian's Last Name. Parent or Guardian's Phone Parent or Guardian's E-mail. Retype E-mail: Parent Street Address Parent City Parent State Parent Zip Code Parents' Home Church (*) Students' Home Church (*) Student Information Student's First Name (*) Student's Last Name (*) Student E-mail (*) Retype E-mail (*) Student Cell Phone (*) Student Gender (*) -Select One-MaleFemale Student Birth Date (*) Is the student's address the same as the parent's address? (If "yes" skip address) -Select One-YesNo Student Street Address Student City Student State Student Zip Code Is your attending student a professing Christian?(*) NOTE: Our retreat is geared toward professing Christian teens. -Select One-YesNo Does attending student make friends easily? (*) NOTE: We won't make this public but our staff and volunteers will subtly work to help your student meet like minded friends. -Select One-YesNo Is your student coming to us with any particular doubts, questions, hurts, or objections? (*) NOTE: We won't make this public but our staff, volunteers, and speakers will subtly work to help your student unpack this. -Select One-YesNo If "yes" please explain: If your student wishes to room with a particular friend, please name them. Student Medical Information Emergency Contact Name / Phone (*) Does attending student have any medical problems or known allergies to medicines, plants, food, etc.? (*) -Select One-YesNo If "yes" please explain: List all medications camper will bring to camp: Is your student able to administer their own medications? -Select One-YesNo If "no" please explain. Parent Night Presentation Will you be attending our parent night presentation on Friday, July 21 at 6PM? (*) -Select One-YesNo Will you be bringing guests? (You may bring up to 5 guests) (*) -Select One-YesNo How many guests will you be bringing? (*) Liability, Medical, and Audio/Video Information Download our Waiver here. NOTE: By registering for this event and initialing below you agree to all the terms and conditions in the above mentioned waiver. Yes I read and agree to the terms and conditions in the above mentioned waiver. Initials (*) Date (*) Help Us Reach More Students Tell us how you heard about us. (*) Would you be willing to email few retreat flyers to interested friends and pastors?: (*) -Select One-YesNo If "yes" we will email you an electronic flyer with recommended email language. Will you commit to pray for ReThink315 students & staff? You will receive one prayer email per month: * -Select One-YesNo Payment Information Payment Method:(*) I am paying by check.I am paying online. Do you have a $50 off discount code?: -Select One-YesNo What is your discount code? OPTION 1: To pay tuition by check, please mail your check to: ReThink315 P.O. BOX 494 Wentzville, MO 63385 Make payable to: ReThink315 OPTION 2: To pay student tuition by credit or debit card, click the link below after you submit this registration form: CLICK HERE TO PAY TUITION ONLINE NOTE: If you pay online, don't forget to come back and finish this registration page. I would like to learn how I can help sponsor the tuition of a student less fortunate than mine.(*) -Select One-YesNo If "yes", send a separate check for any amount and write "student sponsorship" in the memo line. Sponsorships are tax deductible. Almost Finished! After submitting this form, you will receive a registration confirmation email. If you do not receive that email please check your spam folder first then contact our Executive Director, Jeremy Smith, at jsmith@ReThink315.com, or our Operations Director, Daniel DeFonce, at ddefonce@ReThink315.com. Δ