1. Date of Birth is required
2. Select one to fill in Relationship column: Self, Parent, Spouse, Child, Brother, Sister, Friend, for room arrangement.
3. Select language preference:
   English (E)
   Cantonese (C)
   Mandarin (M)
4. Meal & Lodging Plans legend: Meal (M), Accommodation (A)
5. Topic selection is for Chinese program only, please skip this item
6. Two twin-size beds per room. No lodging fee required for children (0~11) staying in the same room with parents (BYO sleeping bag).
7. Age cut-off date is 7/1/2005, 12:00AM (mid-night)
8. Deadline for early registration is 6/5/2005. After 6/5/2005, please register on site and add $5.00 each for late registration fee.
9. Children programs for aged 4 and up are provided by the Word of Life. Registration fee for each child is required.
10. Minors (under 18 years of age) who are not accompanied by the parents, are required to complete the registration form AND Medical Release form AND Entrustment form with parent/guardians’ signature. See Church Rep for forms.
11. As parent/guardian of minor(s) (under 18 years of age) listed in the Registration Form, You agree to take full responsibility of him/her during this Retreat. You have read the retreat rules and agree to have the minor(s) abide by them, in particular:

• Follow the program schedule and attend all meetings and activities;
• No minors are allowed to leave the campus without accompany or written permission of the parent/guardian.
• No possession of weapons or illegal substance/drugs is allowed on the campus.Your signature assures your agreement to release MCCA from any responsibility in the case the minor(s) is injured or harmed in any way.

Note: Give the completed registration form with payment to your church representative listed under Contacts.Or mail it to: Jeremy Lu, 600 Patterson Rd., Dayton, Ohio 45419. Make check payable to MCCA. After June 5, 2005, please register on site. Room and board is not guaranteed.