2026 Panama City Beach Youth Retreat

2026 Panama City Beach Youth Retreat

July 13th - 17th, 2026
*$75 DEPOSIT DUE BY MARCH 29TH 2026
Cottages Christian Retreat

22026 Front Beach Road, Panama City Beach, Fla. 32413
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Please Select One

Student/ Sibling Info

Students fill this form out to register for Panama City 2026. If you recently graduated or turned 18 you are still considered a student.
1st Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Your Child's Shirt Size (Adult Sizes Only)
2nd Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Your Child's Shirt Size (Adult Sizes Only)
3rd Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Your Child's Shirt Size (Adult Sizes Only)
4th Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Your Child's Shirt Size (Adult Sizes Only)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Emergency Contact Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Do you have any questions?
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Oak City Baptist Church during the selected camp. In exchange for the acceptance of said child’s candidacy by Oak City Baptist Church ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Oak City Baptist Church. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Oak City Baptist Church . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all recreational activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Oak City Baptist Church and its affiliates including Directors, Pastors, Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

A deposit of $75 per child will be due by March 29rd, 2026 to confirm your child's spot on the roster. If the despot is not paid by this date your child's spot will be opened up to the next child on the waiting list. If your child needs assistance, please check one of the boxes below. Payments via check or cash will be accepted. CashApp, PayPal, Venmo will NOT be accepted this year.
If partial scholarship is needed, please put the amount you are able to pay, below.
Confirmation

BY SUBMITTING THIS FORM I AM STATING THAT ALL THE INFORMATION IS AS ACCURATE AS POSSIBLE AND I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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2026 Panama City Beach Youth Retreat

*$75 DEPOSIT DUE BY MARCH 29TH 2026

Cottages Christian Retreat

Student/ Sibling Info