Girls' Retreat 2026!
*Please Note: If you have multiple campers, you will need to fill out a form for each camper! Sorry for the inconvenience!
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Relationship to Camper
*
Are you a member of Jim Ned Valley Church of Christ?
*
Yes
No
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Camper Information
Camper Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Grade:
*
3rd
4th
5th
6th
7th
8th
High School Volunteer
T-Shirt Size (adult sizes)
*
XSmall
Small
Medium
Large
XLarge
YSmall
YMedium
YLarge
Allergies
Medications (please specify when to take and how much)
Anything else we should know about?
Submit
Should be Empty: