His Legacy Retreat - Occupy Campus Ministry

Medical Release Form

Packing List

The 3rd Annual Occupy retreat hosted by Dwelling Point Church will be held at an undisclosed location in St. Robert, Mo. This retreat brings together college students and young adults from all across the midwest region for one explosive encounter.

Name*

E-mail Address*

Telephone*

Student Id or M Number (Please put N/A if not applicable).*

Will you be staying in a tent?*

Will you be riding in the van?*

Are you a vegetarian? *

What day will you be arriving?*

Will you be staying the whole retreat?*

Departure day (If leaving early).

Please list any special food allergies or preferences.

Security Token