Resurgent TEEN RETREAT application

Our desire for this retreat is to maximize connection, community building and impact to our fullest ability. With that in mind we have very specific space limitations thus we will be reviewing applications on a first come first serve basis leaving registration open until all spaces are filled. Please take time to fill out the following application. Do not feel pressure to answer in any specific way. We welcome and celebrate different views and beliefs and simply want to get a feel for who you are and how we can best serve you on this adventure. So please complete the application and questions to the best of your ability with relatively simple/short answers. Any questions can be sent directly to

Name Of Teen *
Name Of Teen
Date of Birth
Date of Birth
Contact Phone *
Contact Phone
please provide link to a song or sample of your music. If you are unable or do not have any current music please put below.
Please provide name and number for a pastoral or spiritual leader who can provide a character reference.
Package Desired *
Please select your desired package and any additional packages for people who may attend with you. You will not be charged for the package until contract is signed.
Payment Preference *
please let us know how you would like to pay. These payment options are an example based on 10 months but all payment plans can be customized to meet your needs.
it can totally be practical and non spiritual if you like... we all know the "christian" answer :)
Besides Music!
Do You Have Any Dietary Restrictions? *
RESTRICTIONS not preferences :) if yes please explain in notes.
Please Read Disclosure And Check Box To Proceed *
imagine artist weekend retreat and that all applications will be reviewed for selection but no applicant or application is guaranteed acceptance. If your application is accepted you will receive additional information and a full agreement for your package to be completed and returned with the payment terms agreed upon in that contract. You also acknowledge and agree that your credit card listed will be charged a one time non refundable application fee in the amount of $39 USD. In the event that your application is accepted this fee will be applied to your selected package balance. This fee is non refundable regardless of application outcome. This charge will appear on your statement from “marked by heaven”.