Name *

First Name

Last Name

Cell Phone Number

(###)

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Name of Emergency Contact

Best contact is either parent, relative, or guardian/adult over 21

First Name

Last Name

Emergency Contact's Cell Phone Number *

(###)

###

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Payment and Waivers *

** Please Read Carefully ** Please make your registration payment at this link (select LSCC San Diego Retreat in the dropdown for Fund): LSCCSD Push Pay Page Pricing Per Person: Children 2 and under - Free Kids (Ages 3-18) Registration - $100 College Registration- $120 Adult Registration - $165 Additionally, please fill out the following waiver for retreat (one per household). Use this group code: LS0524 Click here to sign the waiver form here. Please confirm that you have paid for retreat and filled out the waiver forms

I have sent in my payment for retreat

I have filled out the waivers for retreat

I would like to request a scholarship