MVBA Winter Retreat 2026
January 30-31. Doors open for registration at 5:30 at Grand Oaks. Cost is $40. Forms are due by January 14!
Attendee Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attendee Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Please Select
Male
Female
Birthday
-
Month
-
Day
Year
Date
School Grade
7
8
9
10
11
12
Adult Leader
Other
T-Shirt Size
S
M
L
XL
XXL
XXXL
Church attending with:
Please Select
Bethany
Bogard
Bosworth
Coloma
Enon
FBC Carrollton
FBC Dewitt
FBC Marshall
FBC Nelson
FBC Norborn
FBC Slater
Fish Creek
Gill Memorial
Gilliam
Hale
Heath Creek
McCroskie Creek
Midway
Mt. Leonard
Mt. Pleasant
New Prospect
New Salem
Relevant Church
Rockingham Chapel
Southside Baptist Church
Union Baptist Church: Norborne
Union Baptist Church: Malta Bend
Wakenda
Waverly
Zoar
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number 1
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Phone Number 2
Please enter a valid phone number.
Format: (000) 000-0000.
Youth Pastor/Pastor's Name
First Name
Last Name
Social Security Number (For Adult STAFF only)
Do you give authorization to MVBA to run a background check? (For Adult STAFF only)
Yes
No
Do you have any other names you have gone by (including maiden/married names) (For Adult STAFF only)
Consent: By signing below, I give consent for the above named camper to swim, take field trips, and participate in any program activities, under proper adult supervision
Date signed:
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Medical information
Family Physician
First Name
Last Name
Family Physician Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical allergies
Environmental allergies
Food Allergies
Health Problems
Asthma
High Blood Pressure
Diabetes
ADHD
Hyperactivity
Date of last Tetanus Shot
-
Month
-
Day
Year
Date
MEDICAL RELEASE: I (we) have provided complete and accurate information about this camper/staff member and understand that, in the event medical treatment is required, every effort will be made to contact me (us) or the person named above. However, If I (we) cannot be reached, I (we) give permission to the staff or sponsor to secure the medical services deemed necessary to provide for this campers'/staff member's wellbeing. I (we) also understand that they insurance provided by the Grand Oaks Baptist Association, Inc. is a limited supplemental policy covering only injury and accidents incurred during the event at Grand Oaks. Even then it will be used only to supplement the family insurance.
Signature relation:
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Medication information
Camper will be bringing their own medications to camp
Yes
No
Medications:
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Packing List
Packing List: Please take a screenshot of this list for future reference
Sleeping Bag or twin size sheets
Towel for showering
Change of clothes
Hygiene/toiletry items
Bible
Pen/pencil and notebook
Pillow
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Thanks for registering!
We are so excited to see you at the Winter Retreat this year! Please go Zeffy to make your payment for registering. The cost is $40 per student, unless your local church is giving any scholarships (in which they'll give you a coupon code to use). If you have any questions, please contact your church or the MVBA office at mvbaoffice@gmail.com. Click the submit button to go to the payment link or use the QR code below.
Submit
Submit
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