Memphis Area Friends And Family Retreat Registration Form

Join us for an exciting weekend as we engage in faith, friends, family, and fun at Camp Yorktown Bay located in Moutain Pine, AR, located only 3 hours and 24 minutes from Memphis, on May 13-16, 2027. Our Retreat theme this year is Crazy Faith:The Kind of Faith That Moves Mountains. Enjoy staying at such beautiful retreat center offering a variety of lodging options, surrounded by such a gorgeous lake offering breath taking views and peaceful moments. Refresh, renew, and become spiritually restored. Enjoy time with friends and family, relaxing in nature,worship by the lake, exciting games, group activities, kayaking, canoeing, rock wall climbing,gigantic swing, a nature center with animals to observe and learn about, bonfires, smoores, beautiful group boat rides, and delicious all you can eat prepared meals. You won't want to depart. Looking forward to seeing you there. Please take this time to let us know that you are coming, how many people you are bringing, what activities you would like to do, etc. Your $50 deposit is for your family due between now and January 5, 2027. Please return the rest of your payment installments to Chelise Johnson via Cash App to $CheliseJohnson or cash with your name on an envelope. Please title for a retreat with your name on it so that we can keep a record of who paid. Please also inform me that you have paid via text. The entire amount will need to be paid in full for the Family retreat before going. It is due by May 1, 2027.

Guest Information

Name

First NameLast Name

Birthdate

Date

Email

example@example.com

Cell Number

Format: (000) 000-0000.

Emergency Information

Emergency Contact's Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

How many Adults in your party will be coming to the retreat ?

How many kids or youth in your party will be coming to the retreat?

Please list the name and birthdate of each person attending the retreat below:

Rows	First Name	Last Name	Birthdate	Male/Female
Attendee
Attendee
Attendee
Attendee
Attendee
Attendee
Attendee
Attendee
Attendee

Do you or anyone in your party have any health conditions , health limitations or physical injuries? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, (high or low blood sugar) diabetes, seizures, osteoporosis, etc.) Please put no if this doesn't apply to you or anyone in your family

Please list each person and next to their name, each of their allergies below. We also encourage you to chose housing accommodations with a kitchen so that you can prepare meals specific to your allergies. Please put no allergies if this doesn't apply.

Do you or anyone in your party have any special dietary requirements? (eg: nut-free, gluten-free (please specify if you are celiac), allergies, vegan etc…) Please put no if this doesn't apply to you or anyone in your family

Due to my severe allergies I will need a room with a kitchen (There are only a few limited rooms with kitchens for families with allergies on a first come first serve basis)

Meal Options

How many in your party will need vegan meals ?

Each meal is $8.50 per person and kids under 5 each free. Please select the meal choice that will be best for your family.

Although, some of the food options served at the retreat center have nuts in them. The facility can make nut free meals. So if you opt out of staying in a room with a kitchen, how many in your party will need special prepared nut-free meals?

How many nights will you be staying?

How will you get to the retreat? Will you drive or ride with someone?

Please let us know if you have space in your vehicle for someone to ride with you and how people will you be able to give a ride to and from the retreat?

A non refundable $50 deposit per person and a $100 deposit per family will be required to reserve your retreat meals and housing accommodations. Also a $5 per person recreational activity fee per activity will is required. Please add that to your total. Please put it in an envelope with your first and last name.

Click the link below to check out this short video of Camp Yorktown Bay's beautiful retreat center

https://youtu.be/8RY3HX1boCQ?si=C6FvMbNdAxxrmBEX

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I hereby agree to the following:
I understand that no smoking, drugs, alcohol, profanity, or weapons are allowed at Camp Yorktown Bay. I accept that no one from Word of Life Church, Camp Yorktown Bay staff or volunteers, or South Central Conference workers, will be held liable for any any lost or stolen items or injuries due to negligence. I also understand that if me or anyone in my party/family makes any damages to any property or items belonging to Yorktown bay, that I will be responsible for paying for materials and repairs or replacing all damaged items.

I plan to engage, connect with others, fellowship, have fun, be spiritually renewed, become filled with the Holy Spirit, worship God completely, be set free in Jesus, REFRESH/rest, and allow the Lord to restore me in Him.

We are required to turn in a down payment. I understand that the $25 deposit per person and the $50 per family deposit for the retreat is final with no refund. I understand that the deposit will be subtracted from the total cost. I understand that I need to be paying on this event so that me and my family can go: bi weekly, or weekly installments by May 4. I understand that I can make as many payments as I would like to between now and May 4. I understand that my final payment is due on or before May 4, 2026 5PM. Payments can be made via cash in an envelope with my first and last name given to Chelise Johnson or Pastor Deon Johnson or via Cash app: $CheliseJohnson so that a record of it can be made and then the money turned in.

If the situation arises and I am not able to attend the retreat, already paid costs are non-refundable. Someone else will be able to take my place.

Please electronically sign below saying that you have read the above, fully understand it’s contents, and agree to the terms and conditions stated above.

Signature

Date Signed

Date

Please put your deposit in an envelope or cashap for church Family and Friends retreat, and then give your deposit money to Chelise Johnson or Sister Fox so that we can notate each family or person going. Please select the room type or lodging accommodations and activities you would like to participate.

Please select your lodging, activities, meals, and fees to calculate your total:

Duplex Cabin

each side is $88 per night (sleeps 10-12 people) with bunk beds and one full size bed. You can split the cost but pay one full payment (you will only be charged for the side that you stay one) -$176 total ( $14.67 per person)

$264.00 Quantity

Motel Room

Motel Room- $72 per night (one king bed/ with kitchenette- Sleeps 2)- $144 total

$216.00 Quantity

Motel Room

Motel Room - $60 per night (one queen bed- Sleeps 2) -$120 total

$180.00 Quantity

Motel Room

Motel Room - $72 per night (2 queen beds, ADA accessible-sleeps 4) $144 total (only for families with severe allergies who will be cooking) There is only one room like this

$216.00 Quantity

Motel Room

Motel Room - $72 per night (2 queen beds/ with kitchenette- sleeps 4) $144 total (only for families with severe allergies who will be cooking) There is only one room like this

$216.00 Quantity

Tent Camping

Tent Camping - $10 per night per site (water, restroom facilities) - 4 people. Pay $5 per extra people.

$30.00 Quantity

Activity Fee Per Person

This fee is per person for ages 6 and up. This price includes all activities and the activity fee- bonfire and s'mores, Arts and crafts painting class, 1 hour boat ride, canoeing, kayaking, rock wall climbing, team building activities, basketball, gigantic swing, and leap of faith. .

$25.00 Quantity

5 Meals for entire stay -per person

Fri-1 meal, Sat-3 meals, Sunday- 1 meal

$42.50 Quantity

Kids 5 and under eat free and $12 for all activities . (all activities and required rec fee)

How many kids in your party are 5 and under?

$12.00 Quantity

Total