The Alpha Retreat Registration Form

The Alpha Retreat Registration Form

Rooted Resilience: Brotherhood Beyond Strength
Full Name:*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

City
Phone number*
Please enter a valid phone number.
Email*
example@example.com
Number of Adults: *
Number of Children: *
Ages of Children: *
Is this your first time camping?*

YesNo
Do you have any dietary restrictions/allergies?*

YesNo
If yes, please specify
Emergency Contact Information

Please enter the name of parent or guardian who should be contacted in case of an emergency.
Relationship:*

SiblingParentChildFriendOther
Full Name*

First NameLast Name
E-mail Address*
example@example.com
Contact Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there any additional information you would like to share with us?*
What are your expectations for the Alpha Retreat*
Release and Waiver

I hereby grant permission for my family to participate in the camp program and release the camp and its staff from any liability for injuries or damages that may occur.
Do you permit the use of photographs taken of you at this camping event for publicity purposes, such as in promotional materials, social media, and our website?"

YesNo
Signature

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NOTE: Feel free to bring along preffered snacks, soft drinks/alcohol.
NOTE: Payment for camp should be made via Mobile Money to 0246383849 (Ruth Okaniorkor Okan-Adjetey)

Payment Validates your registration. Thanks
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The Alpha Retreat Registration Form

Emergency Contact Information