W.J. Colen Retreat Registration

Do you know anyone else who might be interested in coming on the Freshmen Retreat? If so, please write their full name below with their email.
How did you hear about the retreat? Please check all that apply!
- Newsletter
- Hillel Staff Member
- Welcome Week Event
- Hillel Website
- Social Media (Facebook, Instagram, Twitter)
- From a member of the Hillel staff
- From a friend
- Other

Parent/Guardian Info
Parent/Guardian 1 Name*
First Last
Parent/Guardian 1 Preferred Email*
Parent/Guardian 1 Preferred Phone Number*
Parent/Guardian 1 Permanent Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 2 Name
First Last
Parent/Guardian 2 Preferred Email
Parent/Guardian 2 Preferred Phone Number
My second parent/guardian has...
Parent/Guardian 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Retreat Fee*
Price:
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*
Card Details
Cardholder Name

Student Info