Name * First Name Last Name Email * ETA for the retreat: * Hour Minute Second AM PM Age Rage: * 20-29 30-39 40-49 50-59 60+ Wife's Name * Children * How many children are in your family? 0 1 2 3 4 5 6 7 8 9 10+ Children's Names What are the names and ages of your children? Ministry as Staff Leader * How many years have you served as a leader on a church staff? Ministry as Lead Pastor * How many years have you served as a lead pastor? Church Home * What is the name of the church where you are currently serving? Years Serving * How many years have you been serving in your current position? Expectations for this retreat: * Choose all that apply: Spiritual Renewal Encouragement and Support New Perspectives Rest and Relaxation Community and Fellowship Other... Other: What are your hopes and expectations for this retreat experience? Topics or Questions: Please list any topics or questions you’d like to try and discuss with Pastor Johnny and Pastor Jeff while at the retreat. Family Prayer Request: Are there any needs we could be praying for regarding your family? Ministry Prayer Request: Is there anything we could be praying for regarding your ministry? Church Prayer Request: What is happening in your church that you would want us to be praying for? List any food allergies: List any special requests, accommodations, or physical limitations: Thank you for attending one of our retreats! We look forward to being able to serve you in the time that you are with us!
