2025 Camp Rice/Empowered Adoptee Retreat

2025 Camp Rice/Empowered Adoptee Retreat - Registration Form

July 17-19, 2025 (Thursday 9:00 a.m. through Saturday 1:30 p.m.), Pearlstone Conference and Retreat Center, 5425 Mt. Gilead Road, Reisterstown, Maryland 21136
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Family Name*
Parent / Adult Adoptee 1 *

First NameLast Name
Parent / Adult Adoptee 2

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone (where you can be reached while at camp)*
Email*
example@example.com
Would you like to receive our newsletters?

YesNoI'm already on your mailing list

Adult Attendees
Not required if you're only registering teens in 9th - 12th grades
Please enter the number of teens and children based on their grade in FALL 2025.
Teens (9th - 12th Grade)
Teens (8th Grade)
Total Number of Teens
This form allows a maximum of 3 Teen registrations. Please register additional 9th - 12th Grade Teens on a separate form.
Children (3 years to 7th Grade)
Toddlers * (under the age of 3 years)
*Parents will be responsible to care for their young toddlers throughout camp hours. Camp Rice Children’s program is for ages 3 and up.
Total Number of Campers
There is an additional fee of $200 for less than 3 campers. You can waive this fee by sharing a room with another family.*

Please add the $200 feeWe will share a room with another familyI am attending the Empower Adoptee Retreat as an adult adoptee (additional fee is waived)
Sharing Room with*
Registration Fees ($)
Would you like to sponsor an adult adoptee counselor? Your contribution is tax-deductible

YesNo
Please select amount*

$305$610Other
Please enter other amount ($)*
Donation Total
Total Fee (when live, this field is hidden and feeds PayPal field)
Total Fee*

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USDCamp Rice 2025
Payment

After completing the remainder of this form you will be taken to our online payment page where you can make your payment with PayPal or a Credit/Debit Card.

Refund Policy
Cancellation by February 29: 75 percent refund.
Cancellation by April 30: 50 percent refund.
Cancellation by June 1: 25 percent refund.
Unfortunately, no refunds will be provided for cancellations made after June 1.

Adult 1*

First NameLast Name
T-shirt Size (adult 1)*
Please sign Adult 1 up for*

Adult Adoptee TrackAdult Program (adoptive parents)Not sure -- please contact me with more information.
Adult 2*

First NameLast Name
T-shirt Size (adult 2)*
Please sign Adult 2 up for*

Adult Adoptee TrackAdult Program (adoptive parents)Not sure -- please contact me with more information.
Teen 1*

First NameLast Name
Date of Birth (teen 1)*

MonthDayYear
Date
Gender (teen 1)*
Birth Country (teen 1)*
T-shirt Size (teen 1)*
Grade in upcoming Fall academic calendar (teen 1)*
Teen 2*

First NameLast Name
Date of Birth (teen 2)*

MonthDayYear
Date
Gender (teen 2)*
Birth Country (teen 2)*
T-shirt Size (teen 2)*
Grade in upcoming Fall academic calendar (teen 2)*
Teen 3*

First NameLast Name
Date of Birth (teen 3)*

MonthDayYear
Date
Gender (teen 3)*
Birth Country (teen 3)*
T-shirt Size (teen 3)*
Grade in upcoming Fall academic calendar (teen 3)*
Child 1*

First NameLast Name
Date of Birth (child 1)*

MonthDayYear
Date
Gender (child 1)*
Birth Country (child 1)*
T-shirt Size (child 1)*
Grade in upcoming Fall academic calendar (child 1)*
Child 2*

First NameLast Name
Date of Birth (child 2)*

MonthDayYear
Date
Gender (child 2)*
Birth Country (child 2)*
T-shirt Size (child 2)*
Grade in upcoming Fall academic calendar (child 2)*
Child 3*

First NameLast Name
Date of Birth (child 3)*

MonthDayYear
Date
Gender (child 3)*
Birth Country (child 3)*
T-shirt Size (child 3)*
Grade in upcoming Fall academic calendar (child 3)*
Toddler 1*

First NameLast Name
Date of Birth (toddler 1)*

MonthDayYear
Date
Gender (toddler 1)*
Toddler 2*

First NameLast Name
Date of Birth (toddler 2)*

MonthDayYear
Date
Gender (toddler 2)*

Will you need handicapped accessible bathroom facilities?*

NoYes
Lodging for family campers: hotel style rooms can accommodate up to 6 campers (2 queen sized beds + 1 futon sofa). If family size exceeds 6, then the family may request for rollaway bed(s).
Number of rollaway beds requested*

none12
Please indicate any campers who have allergies (You will receive an additional form for teen campers): Food allergies will be accommodated by the kitchen staff.
Please use space below to provide any comments or special requests:

Signature*

Payment Methods

Debit or Credit Card

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

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2025 Camp Rice/Empowered Adoptee Retreat - Registration Form