We are so excited that you are registering for The Chimes Retreat 2024! We are having two sessions this year!

Session A will be Wednesday, July 17th through Friday, July 19th.

Session B will be Friday, July 19th through Sunday, July 21st.

The cost to attend the retreat is $99, with a $3.96 dollar processing fee. Payment information must be included at the end of this from in order to submit and secure your registration. Thank you! If you have any questions, please email [email protected]

For more information, such as camp location, retreat schedule, and ministry partners, check out thechimesretreat.com

Tickets	Price	Fee
The Chimes Retreat Session A Wednesday, July 17th - Friday, July 19th	$99.00	$3.96

The Chimes Retreat Session B Friday, July 19th - Sunday, July 21st	$99.00	$3.96

Total: $0.00

Student Information

Name

Preferred Name

Gender

Male
Female

Phone Number

Email address

Address

Hometown

Name of High School

Hometown Church (if applicable)

Any allergies or dietary restrictions?

Are you an incoming freshman or a transfer student?

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Second Parent/Guardian Email Address

The Chimes Retreat

T-Shirt Size

If you need to arrive late to the retreat or leave early, specify here.

Will you need any special accommodations at the retreat?

Roommate Request** (Optional, but if you choose to request a roommate, please only request one person!)

Initial here to acknowledge that you are aware that pictures and videos will be taken at The Chimes Retreat and may be used for promotional materials

How did you hear about The Chimes Retreat? (SELECT ALL POSSIBLE CHOICES)

Social Media
Friend/Family
Church
Other

Assumption of the Risk and Release of Liability

This is a liability waiver for the retreat. It is important for you to read and acknowledge the risks associated with attending.

I have read and agree to the terms above.

Electronic Signature Student

Electronic Signature Parent

Note: The cost of The Chimes Retreat is $99 + a fee of $3.96. Once you complete this form, you will be prompted to pay. There will be a $25 processing fee for any student that withdraws from the retreat before July 1, but the rest of the fee will be refunded. After July 1, there are no reimbursements upon withdrawal from The Chimes Retreat.

**We will do our best to accommodate roommate requests, but we cannot make any guarantees.

Note: Airport pick-up/drop-off

For those traveling from out of state to The Chimes Retreat, we offer pick-up and drop-off services to and from the Birmingham and Atlanta airports for no additional cost.

Will you need pick-up/drop-off services to/from the airport?

Coupon Code

Total

$0.00

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

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The Chimes Retreat Session A

The Chimes Retreat Session B

Student Information

Parent/Guardian Information

The Chimes Retreat

Assumption of the Risk and Release of Liability

Billing Information