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 18 years old or older. *Skip parent / guardian info.
YesNo

I am 17 years old or younger. *Please have your parent or guardian complete this form.
YesNo

How concerned are you about the possible transmission of COVID-19 at this retreat?
- Choose One -Extremely ConcernedMaybe a little concernedNot concerned at all

Add a personal note detailing any special concerns you might have:

I 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:

NOTE: If you checked "extremely concerned" you may want to think and pray about skipping this event. Our leaders and the venue workers will be honoring all local CDC guidelines for indoor / outdoor public gatherings and meal services. However, students will have an appropriate amount of "personal liberty" during their stay. While indoors, we will group and separate students according to their comfort levels and will, to the best of our ability, take every precaution to ensure everyone's safety.

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

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 (*)

Student Street Address

Student City

Student State

Student Zip Code

Is attending student a professing Christian?
NOTE: Our retreat is geared toward professing Christian teens. (*)
-Select One-YesNo

Does attending student make friends easily?
(NOTE: If "no" our staff will work discretely to help your student make friends and feel welcome.) (*)
-Select One-YesNo

If your student wishes to room with a particular friend, please name them. (All rooms have a capacity of 2 students.)

Student Medical Information

Emergency Contact Name / Phone (*)

Does attending student have any medical problems, dietary restrictions, or known allergies we should know about? (*)
-Select One-YesNo

If "yes" please explain:

List all medications camper will bring to camp. Type? Dosage? Frequency? Purpose?

(NOTE: All medications must come in the ORIGINAL LABELED CONTAINERS and must be checked in with the camp nurse.)

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 Sunday July 18 at 6PM? (*)
-Select One-YesNo

Will you be bringing guests? (You may bring up to 1 guest.) (*)
-Select One-YesNo

Liability, Medical, and Audio/Video Information

Download our Waiver here.

By entering my initials below I am acknowledging that I have read and agree to the terms of the Liability, Medical, and Audio/Video Waivers. (*)

Date (*)

Help Us Reach More Students

Tell us how you heard about us. (*)

Would you be willing to forward an electronic retreat flyer to friends and family? (*)
-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

1. Mail your check to:

ReThink315
P.O. BOX 494
Wentzville, MO
63385

Make Payable to: ReThink315

Sorry, we cannot accept credit card payments at this time.

NOTE: Payment is due on or before July 1 unless other arrangements are made.
Email our Director, Jeremy Smith at jsmith@ReThink315.com to make special arrangements.

2. Do you have a $50 off discount code?(*) Write the code in below and deduct $50 from your check.
-Select One-YesNo

Type in discount code here:

3. Would you like to help sponsor a student less fortunate than yours.(*)
-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 along with links to Frequently Asked Questions, Retreat Rules, Covid-19 Precautions, Copies of the Waivers, and a Supply List. If you do not receive that email please check your spam folder first then contact our Director, Jeremy Smith, at 314-803-8800 or jsmith@ReThink315.com.

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