Fall Retreat Registration

"*" indicates required fields

Youth Fall Retreat 2026

Contact Details

Church Name*

Church Address*

Street Address Address Line 2 City State ZIP Code

Registrant Name*

First Last

Email*

Phone*

Are you the Group Leader?*

Yes

Group Leader Name

If different from above

First Last

Group Leader Email

If different from above

Attendee Details

Number of Students*

Number of Adult Chaperones (including Group Leader)*

Background Checks

A statewide criminal background check (for the state in which the adult resides) will need to be conducted for every adult chaperone in your group. Any official state background check that you have conducted within the last three years is acceptable. Thank you for making the effort to protect the well-being of our students. I certify that our church, named above, has conducted a statewide criminal background check for each person listed above, and we affirm them as an adult chaperone for this event. I further certify that I am an official representative of the church.

I certify that background checks have been completed

Payment Details

Payment Type*

Please choose whether you are paying a deposit or the total in full.

Deposit Amount

A 50% deposit per person is required at the time of registration. Please add the total number of participants including chaperones here. If paying in full enter 0 here.

Price: $57.50

Full Amount

You may choose to pay the full registration price now. If paying in full, please enter total number of participants including chaperones.

Price: $115.00

Total

Payment Preference*

Check

Credit Card

Check Payment

Please be sure to send in your check to CBF Virginia at PO Box 425, Midlothian, VA 22321.