Type of withdrawal:

Date of Withdrawal:

Name and surname:

Complete address (include city, state and zip code):

Phone:

Email:

Date of Birth:

Do you attend a Connection Group?

Name and Phone Number of two people living in the City of Las Vegas, NV.

Are you a minor?

Name of your parent or guardian.

Voluntary attendance signature. Complete the following paragraph:

I I am willing to go to the Three Days of Power retreat (or a 3Formation), and I state for the record that no one is forcing or pressuring me to attend said retreat, I am going voluntarily and I commit myself to finish the three days and to respect the schedules and rules of said event. Any married couple attending the retreat will not be able to sleep together, because there are separate bedrooms for men and women.

I understand that I am responsible for any damage caused by me and will be responsible to pay for any necessary repairs, I consent to receive any treatment by any doctor, nurse or hospital or emergency room if necessary. I release Aguilas Christian Family Center and Assemblies of God from any accident, illness or contagion of Covid 19, as well as any damages or expenses incurred.

Note: To cancel your attendance you must notify us at least the Sunday prior to the retreat, otherwise we will not be able to refund your deposit.