Living River Summer Camp Registration

Covenant Mountain, Gulftreat, and Living River Counselor Reunion Retreat, Dec. 14-15

We're really looking forward to having former Covenant Mountain, Gulftreat, and Living River counselors to Living River. The retreat will be a casual weekend with good food, time outdoors, and time with friends. Every room in the lodge has two beds. Three of the motel-style rooms have a queen bed and three have two twin beds. The week of the retreat, you'll receive an email with details including the size sheets you must bring. Email office@ livingriver.org with any questions. We hope to see you soon at Living River!
General Information
Name*

First NameLast Name
Cell Phone*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please select which housing situation/rate you're reserving:*

Bunk-style Cabin/ $60One Person Booking Room w/Shared Bathroom in Lodge/ $90Two People Booking Room w/Shared Bathroom in Lodge/ $135One Person Booking Motel-Style Private Room w/Private Bathroom/ $110Two People Booking Motel-Style Private Room w/Private Bathroom/ $170
If registering two people, who is the other participant not listed above?
Participant's First and Last Name
If in a bunk-style cabin or shared bathroom rooming situation, are there other participants you'd like to be with?
Emergency Contact (other than someone who will be with you at Living River)*

First NameLast Name
Emergency Contact phone number *

Area CodePhone Number
E-mail*
Dietary Allergies/ Restrictions
Do You Require an Epi Pen*

YesNo
Other allergies (bee stings etc)/restrictions
Do you require the use of an inhaler?*

YesNo
List any medical conditions of which the leadership team should be aware
Acknowledgements and Releases
Photo release and permission to contact*

I give permission for any photos or videos taken of me during the event by the Presbytery of Sheppards and Lapsley and/or Living River to be used for the public relations of the program.I do not give permission
Medical authorization and release*

Should I sustain or incur any accident or illness while at the event, I hereby authorize the Director and/or the Health Care provider to execute any and all documents in my behalf, including necessary releases, which might be required by a medical facility to perform emergency careI do not give permission
Accident Insurance Disclaimer*

I understand I am responsible for all incurred medical expenses while at Living River
Release and Disclaimer Signature

Clear
Payment

If selecting one of the two "Pay Later" options, you can skip the "Pay Now" and "Payment Methods" sections and submit the form! If paying now, go through the "Pay Now" and "Payment Methods" sections, submit the form, and then go through the PayPal process. Email office@livingriver.org with any questions. Thank you!
Payment Options*

Pay Later By Check - made payable to Living RiverPay Later by PayPal - PayPal invoice sent to me from Living RiverPay Now by PayPal - select one of the options below
Pay Now
prevnext( X )
Bunk-style Cabin$60.00

One Person Booking Room w/Shared Bathroom in the Lodge$90.00

Two People Booking Room w/Shared Bathroom in the Lodge$135.00

One Person Booking Motel-Style Private Room w/Private Bathroom$110.00

Two People Booking Motel-Style Private Room w/Private Bathroom$170.00

Total $0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Covenant Mountain, Gulftreat, and Living River Counselor Reunion Retreat, Dec. 14-15

General Information

Acknowledgements and Releases

Payment