Breakthrough Young Adults Retreat 2026

Breakthrough Young Adults Retreat 2026

TEXOMA YOUTH CAMP
Theme: IGNITE

1 Timothy 1:6-7 For the same reason I remind you to fan into flame the gift of God, which is in you through the laying on of my hands, for God gave us a spirit not of fear but of power and love and self-control.

Who: Young Adults

Where: Texoma Youth Camp

26368 Preston Bend Rd,

Pottsboro, TX 75076

When: Janurary 9th-11th, 2025

Check in: 7pm, Friday

Check out: 10am, Sunday

Cost: $75

*Deadline to register is December 20th, 2025.
Personal Information

Breakthrough Retreat
Name*

First NameLast Name
Sex*
Cell #*
Please enter a valid phone number.
T-Shirt Size*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Age*
Date of Birth

MonthDayYear

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship *

Medical Information
Name of Physician: (if you do not have one please note NONE)*
Physician Phone Number
Please enter a valid phone number.
Is the participant covered by medical/hospital insurance*

YesNo
If so, indicate carrier or plan name
Policy or Group #
Member Services Phone Number
Please enter a valid phone number.

Allergies and Medications
Non Food Allergies*
If none please type NONE KNOWN
Food Allergies*
If none please type NONE KNOWN
Medications being taken: Please list all medications including over the counter or non-prescription drugs. Bring enough medication to last the entirety of camp. Keep it in the ORIGINAL packaging / bottle that identifies the prescribing physician, name of the medication, dosage, and frequency of administration*

YesNo
Current Medications, Dosage, Frequency / Times, Instructions
List each medication / dosage / frequency / instructions by line

Waiver of Liability

In consideration of the privilege of visiting Texoma Youth Camp and attending Liberty Youth Camp, I hereby expressly release, waive, hold harmless and indemnify Texoma Youth Camp “Camp” and Liberty Youth Camp, its directors, officers, volunteers and staff, other camp users, and representatives and their families, heirs and assigns, from any and all accidents or mishaps of any nature which result in personal injury, death, pain or damage to any persons, or damage to any property arising from, or in any manner related to, directly or indirectly, my or my minor child’s recreational, social or other activities in any form (specifically fishing, boating, camping, athletics, swimming, etc.) at or in any way related to Texoma Youth Camp or Liberty Youth Camp. Other examples include but are not limited to, poisonous snakes, wild animals, ticks, chiggers, spiders, stickers, poison ivy, poison oak, animal dens or burrows, mud holes, or other conditions that may present a hazard to campers and recreational users. Please cover the following rules with your camper to help prevent injury.
These safety rules will be observed at all times:

All campers are directed to use care with their fishing hooks at all times to avoid injury to themselves and others.

No guns or weapons of any kind will be brought to Texoma Youth Camp.

All campers under the age of 18 will wear a life jacket when in any boat used in connection with visiting the camp.

No alcoholic beverages will be permitted on the camp property.

Any other instruction or authorized rule given by camp staff.

I give Texoma Youth Camp and Liberty Youth Camp permission to publish in print, electronically, or video format the likeness or image of my child. I release all claims against Texoma Youth Camp and Liberty Youth Camp with respect to copyright ownership and publication including any claim to compensation related to the use of the materials. I have read and understand all of the above printed information and agree to the terms by which my child may attend Liberty Youth Camp located at the Texoma Youth Camp facility.
I have read and understand Medical Release and Waiver of Liability*

First NameLast Name
Initial*
Signed this day*

MonthDayYear
Breakthrough Retreat $75.00*

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Breakthrough Young Adults Retreat 2026

Personal Information

Emergency Contact Information

Medical Information

Allergies and Medications