Please complete this travel reservation form completely. You must enter legal name as it appears on your travel documents. You will receive an email confirmation from us once this form is complete and payment has been processed. If you have any questions while completing this form, please contact us at info@teenkick.org. **Please note: Parents permission is required to travel with Teen KICK. All payments are non-refundable. By completing your registration you are agreeing to these terms.

NON-SCHOLARSHIP REGISTRATION BELOW:

Teen First Name *

Teen Last Name *

Teen Birthdate *

Teen Current Grade *

How did you hear about the retreat? * 🛈

Email Address * 🛈

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Emergency Contact Name: *

Relationship to Teen: *

Emergency Contact Phone Number: *

T-Shirt Size *

Choose Your Payment * 🛈

$250 Pay in Full **Before May 1st**

$300 Pay in Full *After May 1st*

Current Total:

0.00

Yes, I accept your terms and conditions. * 🛈

Agree