Page 1 of 1

Orange Coast Church Retreat

Submit this for with payment by August 16, 2025

Please complete ONE FORM PER ROOM. This form collects your family information, lodging preferences, and payment method. Rooms are available on a first-come, first-served basis.

1. PRIMARY CONTACT INFORMATION

2. FAMILY MEMBERS ATTENDING

List the full name and age of each person attending (including yourself).

3. LODGING SELECTION (WITH MEALS)

Each room includes 2 queen beds and 2 single pull-out trundle beds, private full-size bath, linens.

How many adults (age 13+) in your room? (select one)

Number of children (age 4–12) $70/Child

Number of children (age 0–3) FREE

Do you need a room with accessibility accommodations (ADA)?

Do you have any specific requests or allergies we should know about?

4. PAYMENT INFORMATION

You will be redirected to an online payment service after you submit your form. We believe no one should miss this retreat due to cost. If you would like to request financial assistance, please check below:
Untitled checkboxes field

5. TOTAL COST CALCULATION

Please summarize your family’s total amount due here by adding Adults + Children:

Adults (Age 13+)

Children (Age 4–12)

Total Amount Due

Take note and remember the total amount due to pay online after submit

Remember

- Includes 2 nights and 5 meals per person.
- Check-in begins Friday, August 22 at 4:00 PM.
- Check-out is Sunday, August 24 by 11:00 AM.
- Rooms include 2 queen beds and 2 single pull-out trundles.
- ADA-accessible rooms are available upon request.
- All linens are included.

6. SIGNATURE AND AGREEMENT

By submitting this form, I confirm that the information is accurate and I understand that space is limited and reservations are processed in the order received.

Signature

Signature

Date