HIGH POINT FALL RETREAT 2024

2024 FALL RETREAT REGISTRATION

November 22-24, 2024
Camper Personal Information
Camper Name*

First NameLast Name
Camper Birthday*

MonthDayYear
Camper Age*
Camper Gender*
Camper Cell Phone Number*
Parent/Guardian Information
Parent/Guardian(1)*

First NameLast Name
Parent Cell Phone*
Parent/Guardian(1) Email *
example@example.com
Parent/Guardian(2)

First NameLast Name
Parent/Guardian(2) Cell Phone
Parent/Guardian(2) Email
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name*

First NameLast Name
Phone Number*
Relationship to Camper*
Camp Information
Are you attending as part of a church group?*
If so, what church?
Medical Information
List of any diseases, physical or mental limitations*
Medications currently taking and purpose*
Allergies (food, medical, insects, etc.)*
Restricted Activities *
Family Physician *

First NameLast Name
Physician Phone Number*
Family Medical Insurance Carrier*
Policy Number*
Parental Consent and Liability Release
I understand that High Point has high-risk activities and, due to the nature and its cost, camp insurance is not a possibility. I personally assume all risk for this teenager's safety during his or her weekend experience.

I agree that High Point Camp may use photographs and/or video of my teenager during their stay at camp; without liability and without expectation or receipt of compensation. Including for example, such purposes as publicity, illustration, advertising, and web content.

I have read the terms and conditions located on the High Point website carefully, and I agree to all policies written herein. I personally assume all liability.
I agree with the Parental Consent and Liability Release Statement*

Yes
Parent/Guardian Signature*

Clear

High Point Fall Retreat Payment (select choice) *

High Point Retreat Registration Fee (registration fee is non-refundable)

$100.00

Enter coupon

Total

$0.00

Credit Card

Should be Empty:

2024 FALL RETREAT REGISTRATION

Camper Personal Information

Parent/Guardian Information

Emergency Contact

Camp Information

Medical Information

Parental Consent and Liability Release

Credit Card