Winter '24 Youth Retreats

Winter Youth Retreats
Taste of Camp Retreat (K-6th grade)

Sunday, April 6th: 12:00pm-5:00pm

$30 per participant (lunch included)

Camper Information
Camper Name*

First NameLast Name
Camper Age*
Sex:*

FemaleMaleOther
Preferred pronouns:*
My role at this retreat is:*

a camperan adult leaderchurch staff
Please select the retreat you plan to attend.*

Taste of Camp Retreat (K-6th)
Church name, if applicable:
Please include what town the church is in.
Is there anything we should know about your camper? (allergies, health - if no please type N/A)*

Parent/Guardian Information
Primary Parent/Guardian Name:*

First NameLast Name
Primary Parent/Guardian Phone Number:*
Please enter a valid phone number.
Primary Parent/Guardian Email:*
Primary Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact if primary is unavailable:

First NameLast Name
Emergency Contact Phone Number:
Please enter a valid phone number.
Emergency Contact Email:

Payment Information
Please choose one:*

I am paying fullMy church is paying fullMy church is paying part and I am paying the rest
Church representative:
(if applicable)

Winter Youth Retreat Amount

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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