Youth Worker Retreat

Youth Workers Retreat Registration

October 28-29, 2025
Contact Name*

First NameLast Name
Email*
Phone*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Church/Ministry*
Gender*
Roommate Requests
Note: if you are bringing family members leave this blank. Family info on next page.

Youth Workers Retreat Registration

Family Information
Add other Family to this registration?*

YesNo
For each family member you're bringing, list their name and age.
Family Members*
Family Members List
Participant Count
Who should we contact in case of an emergency for which you are incapacitated? Do not list yourself.
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Anything Else We Should Know?

Youth Workers Retreat Registration

Release and Understanding
Attendees: {contactName}

{familyMembers}
I give permission to Camp Elim to use media (video or photographs) of my family for promotional purposes*

YesNo
Please note any exceptions to the Media Release.
Signature*

Clear
By signing I agree to the statements in this form
Date

MonthDayYear
Date
Click Submit, you will be emailed a copy of your registration.

Also look for the button to complete a Dietary Restrition form if needed on the following confirmation page, there is also a link in your email confirmation.
Should be Empty:

Youth Workers Retreat Registration