ACC Pine Valley Retreat Family Application

ACC Pine Valley Retreat Family Application

This is the application form for families with children. If you would like to register a single individual, please click the "Individual" application. All rates include a $20 non-refundable registration and processing fee. You are not fully registered until the application, liability form(s), and full payment have been received.
Important Form Disclaimer

Please ONLY use this form if you are registering individuals such as your children/spouse who have the SAME INFORMATION as you such as address, home church, guardian, etc. If this does not apply to you, please refer to the Individual Application.
Guardian/Parent Full Name - 1

First NameLast Name
Gender - 1
Marital Status
Phone Number - 1
Please enter a valid phone number.Format: (000) 000-0000.
Email - 1
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Age at the time of retreat - 1
Years in the faith - 1
Home Church
City
Day & Time of Arrival at Camp
I am willing to volunteer in the following ways - 1:
Comments regarding volunteering - 1
Nominees for PV Committee

Please note that the term of two brothers on the Pine Valley Committee, Michael Greeninger, Andrew Gerber is expiring this year. We are taking names for two potential nominees at this time. The current P.V. Committee is Ben Albu, Bryan Bodjanac, Andrew Gerber, Michael Greeninger, and Arnold Sabo
Names of potential nominees
Registering spouse?
Guardian/Parent Full Name - 2

First NameLast Name
Gender - 2
Phone Number - 2
Please enter a valid phone number.Format: (000) 000-0000.
Email Address - 2
example@example.com
Age at the time of retreat - 2
Years in the faith - 2
I am willing to volunteer in the following ways - 2:
Comments regarding volunteering - 2
Nominees for PV Committee

Please note that the term of two brothers on the Pine Valley Committee, Michael Greeninger, Andrew Gerber is expiring this year. We are taking names for two potential nominees at this time. The current P.V. Committee is Ben Albu, Bryan Bodjanac, Andrew Gerber, Michael Greeninger, and Arnold Sabo.
Names of potential nominees - 2
How many children would you like to also register?
Reminder: This is recommended for families with children under the age of 18.
First Child Name

First NameLast Name
First Child Gender
First Child age at the time of retreat
First Child Lodging Request (2 names)
Second Child Name

First NameLast Name
Second Child Gender
Second Child age at the time of retreat
Second Child Lodging Request (2 names)
Third Child Name

First NameLast Name
Third Child Gender
Third Child age at the time of retreat
Third Child Lodging Request (2 names)
Fourth Child Name

First NameLast Name
Fourth Child Gender
Fourth Child age at the time of retreat
Fourth Child Lodging Request (2 names)
Fifth Child Name

First NameLast Name
Fifth Child Gender
Fifth Child age at the time of retreat
Fifth Child Lodging Request (2 names)
Sixth Child Name

First NameLast Name
Sixth Child Gender
Sixth Child age at the time of retreat
Sixth Child Lodging Request (2 names)
Seventh Child Name

First NameLast Name
Seventh Child Gender
Seventh Child age at the time of retreat
Seventh Child Lodging Request (2 names)
Eighth Child Name

First NameLast Name
Eighth Child Gender
Eighth Child age at the time of retreat
Eighth Child Lodging Request (2 names)
Ninth Child Name

First NameLast Name
Ninth Child Gender
Ninth Child age at the time of retreat
Ninth Child Lodging Request (2 names)
Tenth Child Name

First NameLast Name
Tenth Child Gender
Tenth Child age at the time of retreat
Tenth Child Lodging Request (2 names)
Please note: All rates are per person and include a $20 non-refundable fee. Please use the quantity selector for family members who will be under the same package.

Rates

Motel - Full Time - ages 12+

Full time with meals, linens included

$310.00 Quantity

Dorm - Full Time - ages 12+

Full time with meals

$270.00 Quantity

Family Dorm - Full Time - age 12+ (min. 6 people)

Full time with meals

$270.00 Quantity

Dorm - Part Time (1 night) - ages 12+

3 meals

$200.00 Quantity

Dorm - Part Time (2 nights) - ages 12+

6 meals

$230.00 Quantity

Ages 8-11 - Full Time

Full time with meals

$135.00 Quantity

Ages 4-7 - Full Time

Full time with meals

$120.00 Quantity

Ages 3 and under - Full Time

Full time with meals

Free Quantity

Day Registration - Part Time - Child (ages 3 and under)

Free Quantity

Day Registration - Part Time - ages 12+

No meals

$50.00 Quantity

Day Registration - Part Time - ages 4-11

Includes lunch OR dinner

$40.00 Quantity

Day Registration - Part Time - ages 12+

Includes lunch OR dinner

$65.00 Quantity

Day Registration - Part Time - ages 4-11

Includes lunch AND dinner

$55.00 Quantity

Day Registration - Part Time - ages 12+

Includes lunch AND dinner

$85.00 Quantity

Full Registration - Off-site Lodging

ALL meals

$160.00 Quantity

Linens (per bed)

$35.00 Quantity
Item subtotal:

Donation

as unto the Lord

$5.00

Amount	Quantity	Price
$5		$5.00
$15		$15.00
$25		$25.00
$50		$50.00
$100		$100.00
$150		$150.00
$200		$200.00

Item subtotal:

Total

Family Member Details
Please list the names of each family member and which package/items they are receiving.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: