CCL 2021 Registration Form

2021 CCL Conference Registration

Fill out the form to register for the 2021 Christian Camp Leaders Conference at Country Lake Christian Retreat in Underwood, IN - January 25-28, 2021
PRICING:

Main Lodge Double Occupancy - $275
(There are 50 hote-stlyle double rooms in the Lodge. Married couples who register will receive first consideration for these hotel rooms. If there is a need to make adjustments in lodging you will be contacted at a later date.)

Dorm Style Lodging - $200

No Lodging (Meals only) - $150

NO RISK REGISTRATION: Full refund if you are unable to attend. Please notify us 2 weeks prior to the conference in order to receive your refund.
Indicate your payment method for your registration: *

Debit/Credit Card or Paypal Check
Name *

First Name Last Name
Camp Name *
What Title/Role BEST describes your position/responsibilities at camp?
Camp Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Camp Phone Number *

Area Code Phone Number
Cell Phone Number (optional)

Area Code Phone Number
E-mail *
example@example.com
Gender *

Male Female
Basic Camping Information
What year did you start in Christian Camping?
Allergies/Medical
Any known food allergies? *

No Yes
Please Check All Food Allergies that Apply *

Peanuts Tree Nuts Eggs Fish (Such as Bass/Cod/Flounder) Shellfish (Such as Crab/Shrimp) Dairy Soy Wheat (Gluten) Diabetic Other
Please Describe Severity of Food Allergy *
Any major health issues we should be aware of? *

No Yes
Please describe the health issue: *
Adventure Activities

We have the opportunity to offer several "adventure activities" on Wednesday afternoon, at no extra cost. Please indicate your interest level in the following activities to help with planning and scheduling.

Zip Line

	1	2	3	4	5

1 is No Interest, 5 is High Interest

High Ropes Course

	1	2	3	4	5

1 is No Interest, 5 is High Interest

Paintball

	1	2	3	4	5

1 is No Interest, 5 is High Interest

Axe Throwing

	1	2	3	4	5

1 is No Interest, 5 is High Interest

Room Type/Cost
Type of Lodging *

Double Room - $275 (One Roommate) Dorm Room - $200 (Multiple Roommates) No Lodging; Just Meals and Programming - $150
Will you have any children attending with you? *

Yes No
CHILDCARE will be offered on Tuesday, 11 a.m. to 4 p.m. and Wednesday 11 a.m. to 2:30 pm. This is for children who are totally self-sufficient in the restroom up through 5th grade. Younger children are welcome if they are accompanied by a parent or older sibling.

YOUTH ACTIVITIES for 6th grade and up will be offered on Tuesday only, 11 a.m. to 4 p.m.

Please use the following fields to register your children for the conference and to indicate if you plan to use these services.
How many children ages 0-5 (as of Jan. 11, 2020) will be attending?
How many children ages 6-15 (as of Jan. 11, 2020) will be attending?
Please list the name and age of each child attending with you.
Please also indicate if each child will be attending Child Care or Youth Activities
Total Child Cost
Roommate Request
DateTime
Early Bird Deadline

Month Day Year
Date
Date Difference
Double Room Early
Double Room Regular
Dorm Room Early
Dorm Room Regular
No Lodging Early
No Lodging Regular
Total Lodging Cost
Donate to Scholarship Fund for other Conference Attendees (enter amount):
Payment Today? *

Deposit Only Pay in Full
Deposit Only
Paypal Amount
Total Registration Cost
Amount Due Today *

prev next ( X )
USD Description
All balances due January 11th, 2021.

If you wish to pay with check for balance due, please address checks to:

NCCLC
Butler Springs Christian Camp
3701 State Route 41
Hilsboro, OH 45133

If you have general questions about the conference please contact Dan Owsley at dan@wondervalleycamp.com
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2021 CCL Conference Registration

Basic Camping Information

Allergies/Medical

Adventure Activities

Room Type/Cost