Middle School Retreat (MSR) 2026

Student Name

Students Phone (If Applicable)

Parents Name

Parents Phone

Parents Email

This address will receive a confirmation email

Gender

Male Female

Grade

6 7 8

What church do you attend? (If you attend church at ACV on Sundays or for youth please put ACV)

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

October 30-November 1

Please fill out this form and click submit.