Encounter

Thank you for your interest in the Encounter Retreat. We hope you will find it to be a life-changing, spiritual experience.

To register, please fill out this form and return it with your $70 payment to the Crossroads Church office. You may drop off your form and payment to the church office in person, put your form in an offering basket, or return the form by mail to:

Encounter Retreat, Crossroads Church,
Crossroads Drive, Oakdale, PA 15071


Click here to find out more about the retreat.

General information

First Name
Last Name
Nickname
Gender Select a Gender Male Female
Street Address
City
State Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Home Phone - -
Work Phone - -
Cell Phone - -
Email (home)
Email (work)
Age Range Select a Range 19-24 25-30 31-39 40-50 51-59 60-70 Over 70

Church Information

You do not need to be a member of Crossroads Church to attend an Encounter Retreat. The items below are for our information, so that we may help you have an optimal experience at the Encounter Retreat.

Crossroads campus where you usually worship: Select a Campus Oakdale Bridgeville East Liberty
Have you attended Newcomer's Class or the Following Jesus class?

Yes
No

Are you in a small group?

Yes
No
If yes, leaders name
If no, would you like to get connected to a small group?
Yes
No

Health Information

If none, please put None.
Do you have any food allergies?
Do you have any dietary restrictions?
Are you taking any medications that require special attention?
Do you have any physical handicaps?

Emergency Contact Information

In the event of an emergency, please contact the following person:

Name
Phone #1 - -
Phone #2 - -
Relationship to you

Personal Information

Please list 2 people that know you very well: (May be family or friends)
1) Phone - -

Relationship

2) Phone - -

Relationship