Refuge Registration

Use the form below to send us your refuge registration.
NOTE:This form is for refuge registration only.

Your Name*:
Your Email*:
Address:
City:
State:
Zip:
Phone Number:
Monday 5:30 PM Meal Registration (pay upon arrival)?
Yes
No
Number of Refuge Meals for Ages 2-5 ($2 each)?
Number of Refuge Meals for Ages 6-Adult ($5 each)?
Do you need 7:00 PM Childcare (birth through 6th grade)?
Yes
No
Names and Ages of Children Needing Childcare?

Please select which life group you're registering for:
Boundaries
Girlfriends Unlimited
Men's Fraternity - Book 1
Men's Fraternity - Book 2
Dad's 101
Helping Teens
Point Man
Home Front
Colors
Addiction Recovery
Divorce Care
Grief Share
Smoking Cessation
Between Heartache and Joy
Financial Peace University
H20
English as a Second Language
Career Placement
CPR Training
Caring for Your Aging Parents
Still Waiting (Infertility Support)
Wellness - Healthy Family Project
Nutrition & Exercise
Autism
 
* Required Fields